Diagnosing Ventilator-Associated Pneumonia
Author Information
Author(s): Rea-Neto Alvaro, Youssef Nazah Cherif M, Tuche Fabio, Brunkhorst Frank, Ranieri V Marco, Reinhart Konrad, Sakr Yasser
Primary Institution: Friedrich-Schiller-University Hospital, Jena, Germany
Hypothesis
The aim of this qualitative review was to compare various criteria of diagnosing VAP in the intensive care unit (ICU).
Conclusion
An integrated approach should be followed in diagnosing and treating patients with VAP, including early antibiotic therapy and subsequent rectification according to clinical response and results of bacteriologic cultures.
Supporting Evidence
- Clinical criteria, used in combination, may be helpful in diagnosing VAP.
- Bacteriologic data do not increase the accuracy of diagnosis as compared to clinical diagnosis.
- Quantitative cultures obtained by different methods seem to be rather equivalent in diagnosing VAP.
- Blood cultures are relatively insensitive to diagnose pneumonia.
- The rapid availability of cytological data may be useful in initial therapeutic decisions.
- CRP, PCT, and sTREM are promising biomarkers in diagnosing VAP.
Takeaway
Doctors need to use different methods together to figure out if someone has pneumonia from a ventilator, because no single test is perfect.
Methodology
A MEDLINE search was performed using the keywords 'ventilator associated pneumonia' AND 'diagnosis', limited to human studies published between January 1966 and June 2007, including only studies of at least 25 adult patients.
Potential Biases
Inter-observer variability in calculating CPIS was found to be poor.
Limitations
The major limitation of the literature validating CPIS for diagnosing VAP is that BAL culture is not a true gold standard.
Participant Demographics
Studies included adult patients with ventilator-associated pneumonia.
Digital Object Identifier (DOI)
Want to read the original?
Access the complete publication on the publisher's website