{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:54:08Z","timestamp":1790916848070,"version":"4.1.0"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T00:00:00Z","timestamp":1680480000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009127","name":"Invention for Innovation Programme","doi-asserted-by":"publisher","award":["II\u2010OL\u20101113\u201010016"],"award-info":[{"award-number":["II\u2010OL\u20101113\u201010016"]}],"id":[{"id":"10.13039\/501100009127","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014653","name":"Manchester Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014653","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Ventilator\u2010associated pneumonia commonly occurs in critically ill patients. Clinical suspicion results in overuse\u00a0of antibiotics, which in turn promotes antimicrobial resistance. Detection of volatile organic compounds in the exhaled breath of critically ill patients might allow earlier detection of pneumonia and avoid unnecessary antibiotic prescription. We report a proof of concept study for non\u2010invasive diagnosis of ventilator\u2010associated pneumonia in intensive care (the BRAVo study). Mechanically ventilated critically ill patients commenced on antibiotics for clinical suspicion of ventilator\u2010associated pneumonia were recruited within the first 24\u00a0h of treatment. Paired exhaled breath and respiratory tract samples were collected. Exhaled breath was captured on sorbent tubes and then analysed using thermal desorption gas chromatography\u2013mass spectrometry to detect volatile organic compounds. Microbiological culture of a pathogenic bacteria in respiratory tract samples provided confirmation of ventilator\u2010associated pneumonia. Univariable and multivariable analyses of volatile organic compounds were performed to identify potential biomarkers for a \u2018rule\u2010out\u2019 test. Ninety\u2010six participants were enrolled in the trial, with exhaled breath available from 92. Of all compounds tested, the four highest performing candidate biomarkers were benzene, cyclohexanone, pentanol and undecanal with area under the receiver operating characteristic curve ranging from 0.67 to 0.77 and negative predictive values from 85% to 88%. Identified volatile organic compounds in the exhaled breath of mechanically ventilated critically ill patients show promise as a useful non\u2010invasive \u2018rule\u2010out\u2019 test for ventilator\u2010associated pneumonia.<\/jats:p>","DOI":"10.1111\/anae.15999","type":"journal-article","created":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T12:58:43Z","timestamp":1680526723000},"page":"712-721","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Analysis of exhaled breath to identify critically ill patients with ventilator\u2010associated pneumonia"],"prefix":"10.1111","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6868-6633","authenticated-orcid":false,"given":"T. W.","family":"Felton","sequence":"first","affiliation":[{"name":"Faculty of Biology, Medicine and Health, School of Biological Sciences University of Manchester  UK"},{"name":"Department of Critical Care Medicine Manchester University Hospitals NHS Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Faculty of Biology, Medicine and Health, School of Biological Sciences University of Manchester  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I. R.","family":"White","sequence":"additional","affiliation":[{"name":"Laboratory for Environmental and Life Sciences University of Nova Gorica  Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"van Oort","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Academic Medical Centre  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. J. W.","family":"Rattray","sequence":"additional","affiliation":[{"name":"Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Docherty","sequence":"additional","affiliation":[{"name":"Department of Medicine Liverpool University Hospitals NHS Foundation Trust  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Bannard\u2010Smith","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Manchester University Hospitals NHS Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Morton","sequence":"additional","affiliation":[{"name":"Liverpool University Hospitals NHS Foundation Trust  Liverpool UK"},{"name":"Liverpool School of Tropical Medicine  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Welters","sequence":"additional","affiliation":[{"name":"Liverpool University Hospitals NHS Foundation Trust  Liverpool UK"},{"name":"Department of Cardiovascular and Metabolic Medicine Institute of Life Course and Clinical Sciences, University of Liverpool  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"McMullan","sequence":"additional","affiliation":[{"name":"Department of Microbiology Belfast Health and Social Care Trust  Belfast UK"},{"name":"Wellcome\u2010Wolfson Institute for Experimental Medicine, Queen's University Belfast  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. A.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Faculty of Biology, Medicine and Health, Centre for Biostatistics, School of Health Sciences University of Manchester  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Goodacre","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Systems Biology Institute of Systems, Molecular and Integrative Biology, University of Liverpool  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. M.","family":"Dark","sequence":"additional","affiliation":[{"name":"Faculty of Biology, Medicine and Health, School of Biological Sciences University of Manchester  UK"},{"name":"Northern Care Alliance NHS Group, Greater Manchester  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. J.","family":"Fowler","sequence":"additional","affiliation":[{"name":"Faculty of Biology, Medicine and Health, School of Biological Sciences University of Manchester  UK"},{"name":"Department of Respiratory Medicine Manchester University Hospitals NHS Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,3]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1754"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70081-1"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw504"},{"key":"e_1_2_6_5_1","first-page":"1","article-title":"International ERS\/ESICM\/ESCMID\/ALAT guidelines for the management of hospital\u2010acquired pneumonia and ventilator\u2010associated pneumonia","volume":"50","author":"Torres A","year":"2017","journal-title":"European Respiratory Journal"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-205766"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-008-1237-y"},{"key":"e_1_2_6_8_1","first-page":"1308","article-title":"Association of adverse events with antibiotic use in hospitalized patients","volume":"177","author":"Tamma PD","year":"2017","journal-title":"Journal of the American Medical Association Internal Medicine"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(10)70258-9"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202003-188ST"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.8531"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(19)30367-4"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2010.156695"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-13-72"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-206273"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1039\/C9AN01134J"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/1751143718811113"},{"key":"e_1_2_6_18_1","first-page":"758","article-title":"AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010","volume":"55","author":"American Association for Respiratory Care","year":"2010","journal-title":"Respiratory Care"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1088\/1752-7163\/aae557"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11306-007-0070-6"},{"key":"e_1_2_6_21_1","unstructured":"Public Health England.SMI B 57: investigation of bronchoalveolar lavage sputum and associated specimens. 2015.https:\/\/www.gov.uk\/government\/publications\/smi\u2010b\u201057\u2010investigation\u2010of\u2010bronchoalveolar\u2010lavage\u2010sputum\u2010and\u2010associated\u2010specimens(accessed 14\/02\/2023)."},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2517-6161.1995.tb02031.x"},{"key":"e_1_2_6_23_1","first-page":"7","article-title":"How to develop a more accurate risk prediction model when there are few events","volume":"351","author":"Pavlou M","year":"2015","journal-title":"British Medical Journal"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/143.5_Pt_1.1121"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1088\/1752-7163\/ab7f9d"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep17179"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms18020449"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1088\/1752-7163\/aa8efc"}],"container-title":["Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.15999","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T22:47:05Z","timestamp":1761691625000},"score":1,"resource":{"primary":{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/10.1111\/anae.15999"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,3]]},"references-count":27,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1111\/anae.15999"],"URL":"https:\/\/doi.org\/10.1111\/anae.15999","archive":["Portico"],"relation":{},"ISSN":["0003-2409","1365-2044"],"issn-type":[{"value":"0003-2409","type":"print"},{"value":"1365-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,3]]},"assertion":[{"value":"2023-03-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}