Objective To evaluate the diagnostic accuracy of procalcitonin (PCT) for ventilator-associated pneumonia (VAP). Methods We searched MEDLINE, EMbase, The Cochrane Library, CBM, BIOSIS to identify all diagnostic tests which evaluated the diagnostic value of PCT in patients with VAP. QUADAS items were used to evaluate the quality of the included studies. Pooled sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), summary receiver operating characteristic (SROC) curve, and the heterogeneity of the included studies were calculated by using the Meta-disk software. Results Five studies which were identified from 103 references met the inclusion criteria. The summary sensitivity, specificity, +LR, and –LR values were 0.70 (95%CI 0.62 to 0.77), 0.76 (95%CI 0.69 to 0.82), 5.651 (95%CI 1.237 to 25.810), and 0.349 (95%CI 0.155 to 0.784), respectively. Overall area under the curve (AUC) of SROC curve was 0.884 (DOR=19.416, 95%CI 2.473 to 152.47), demonstrating significant heterogeneity (I2gt;50%). Conclusion The use of PCT for VAP diagnosis has only a moderate sensitivity and specificity. Although the overall accuracy of VAP diagnosis is relatively high, there is significant heterogeneity between the studies, so more high-quality studies are needed. Besides, using PCT alone to diagnose VAP is not sufficient, and a combination with other clinical evaluations is necessary.
Objective To analyze risk factors and therapy strategies of critically ill patients with acute pulmonary edema(APE)after the 2008 Wenchuan earthquake．Methods Data including the level of hemoglobin，mean arterial pressure(MAP)，central venous pressure(CVP)，serum albumin as well as complications and liquid balance 1 week，3 days，1 day before onset of APE was collected an d an alyzed retrospectively．Resets Among 142 patients during two months after May 12 earthquake APE was detected in 17 cases for 25 times．The hemoglobin Was (86．04 ±16．31)s／L，MAP was(99．40±17．38)mm Hg，CVP Was (13．64 ±4．09)mm Hg and serum albumin was(27．80±8．10)g／L．Acute renal failure，severe infection，cardiovascular disease and extremity lost were more common in APE patients．Theliquid net intake Was (1 725．05±4 624．84)mL for one week，(1 574．70±2 857．13)mL for 3 days and (368．56±1 589．89)mL for 1 day before the onset of APE．The liquid intake Was significantly higher in young group．APE Was alleviated promptly after integrated therapy in all cases．Conclusions Traumapatients with ARF or extremity lost are prone to be compromised with APE．Severe infection and overburden of liquid may be other predisposing factors．