Soluble Triggering Receptor Expressed on Myeloid Cells (S-Trem-1) from Endotracheal Aspirates in Critically Ill Patients: A Potential Marker of the Dynamic Inflammatory Burden of the Lower Respiratory Tract (Report‪)‬

Ventilator-associated pneumonia (VAP) remains a significant cause of mortality in critically ill patients, claiming the lives of up to 50% of those who develop this complication. (1) VAP occurs commonly in the intensive care unit (ICU) setting, with an estimated incidence of 1% per day in the ICU. (2) The high incidence and considerable mortality attributable to VAP mean that clinicians need to maintain a high index of suspicion in any critically ill ventilated patient manifesting a new fever. The survival of patients with VAP is critically dependent on the early administration of appropriate antimicrobial agents. (3) However, the diagnosis of VAP is fraught with difficulty owing to the lack of objective diagnostic criteria and wide-ranging expert opinions on the merits of invasive (bronchoscopically guided) versus non-invasive (endotracheal aspirates) diagnostic procedures. (4) The Clinical Pulmonary Infection Score (CPIS) is commonly utilised as a clinical predictor of VAP, and although lacking in specificity a CPIS 6 can be used as a threshold for the institution of empiric antibiotic therapy. (5)