• Umer Bakali, Chitvan Killawala, Evelise Monteagudo, Michael D Cobler-Lichter, Luciana Tito, Jessica Delamater, Larisa Shagabayeva, Brianna L Collie, Nicole B Lyons, Emre Dikici, Sapna K Deo, Sylvia Daunert, and Carl I Schulman.
• Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL.
• Ann. Surg. 2024 Sep 1; 280 (3): 394402394-402.

ObjectiveEvaluate associations between volatile organic compounds (VOCs) in heat and moisture exchange (HME) filters and the presence of ventilator-associated pneumonia (VAP).BackgroundClinical diagnostic criteria for VAP have poor interobserver reliability, and cultures are slow to result. Exhaled breath contains VOCs related to gram-negative bacterial proliferation, the most identified organisms in VAP. We hypothesized that exhaled VOCs on HME filters can predict nascent VAP in mechanically ventilated intensive care unit patients.MethodsGas chromatography-mass spectrometry was used to analyze 111 HME filters from 12 intubated patients who developed VAP. Identities and relative amounts of VOCs were associated with dates of clinical suspicion and culture confirmation of VAP. Matched pairs t tests were performed to compare VOC abundances in HME filters collected within 3 days pre and postclinical suspicion of VAP (pneumonia days), versus outside of these days (non-pneumonia days). A receiver operating characteristic curve was generated to determine the diagnostic potential of VOCs.ResultsCarbon disulfide, associated with the proliferation of certain gram-negative bacteria, was found in samples collected during pneumonia days for 11 of 12 patients. Carbon disulfide levels were significantly greater ( P = 0.0163) for filters on pneumonia days. The Area Under the Curve of the Reciever Operating Characteristic curve (AUC ROC) for carbon disulfide was 0.649 (95% CI: 0.419-0.88).ConclusionsCarbon disulfide associated with gram-negative VAP can be identified on HME filters up to 3 days before the initial clinical suspicion, and approximately a week before culture confirmation. This suggests VOC sensors may have potential as an adjunctive method for early detection of VAP.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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