Diagnosis and Treatment of Ventilator-Associated Pneumonia—Impact on Survival

Ho, Edward J.; Brehm, Walter T.; Kirkpatrick, Michael B.

doi:10.1378/chest.110.4.1025

Cited by 61 publications

(19 citation statements)

References 43 publications

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“…Despite claims of greater accuracy for invasive testing and a published decision analysis 56 suggesting mortality benefit using an invasive method-based management algorithm, no conclusive evidence of improved mortality exists. Mechanically ventilated patients with a constellation of clinical findings suggestive of pneumonia will have this diagnosis confirmed by invasive testing in about half of the episodes.…”

Section: Diagnostic Methodsmentioning

confidence: 99%

Ventilator-Associated Pneumonia

Morehead¹,

Pinto²

2000

Arch Intern Med

109

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Ventilator-associated pneumonia is a common complication in intensive care units, occurring in 9% to 24% of patients intubated for longer than 48 hours. Because of this large disease burden and the resultant attributable morbidity and mortality, there is great interest in accurately diagnosing, treating, and preventing this complication. More severely ill patients tend to develop ventilator-associated pneumonia, and identified risk factors include prolonged mechanical ventilation, reintubation after failed extubation, and a few other clinical variables. The efficacy of diagnostic and preventive strategies is somewhat controversial. Diagnosis by invasive methods requires a considerable commitment of resources but can potentially reduce cost of care; however, mortality benefit from this approach has not been demonstrated. As such, in most institutions, ventilator-associated pneumonia is best diagnosed using traditional clinical criteria. Prompt administration of appropriate antibiotics seems to be the only intervention that alters outcome once the diagnosis is established. Several strategies seem to reduce pneumonia incidence; however, mortality and cost benefits have yet to be convincingly shown.

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Section: Diagnostic Methodsmentioning

confidence: 99%

Ventilator-Associated Pneumonia

Morehead¹,

Pinto²

2000

Arch Intern Med

109

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“…Such an approach will result in excess antibiotic use with its attendant cost, potential toxicity, and selection of drug-resistant organisms. A recent decision analysis suggested that more deaths occurred if patients were treated with antibiotics on the basis of only clinical suspicion of VAP than if antibiotics were withheld (190).…”

Section: Microbiologic Diagnosismentioning

confidence: 99%

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

2006

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SUMMARY While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This article reviews the literature with regard to diagnosis, treatment, and prevention. It provides conclusions that can be implemented in practice as well as an algorithm for the bedside clinician and also focuses on the controversies with regard to diagnostic tools and approaches, treatment plans, and prevention strategies.

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“…Most investigators prefer BAL over PSB (slightly higher sensitivity and less costly test, most accurate direct examination with the use of cytocentrifuge preparations, possibility to diagnose nonbacterial pulmonary infection, etc.). The potential benefit of a microbiological strategy can be obtained only when physicians accept to prescribe antibiotics based on the results of bronchoscopic specimen cultures and, thus, to withdraw antimicrobial therapy from patients with negative results [58,59].…”

Section: Clinical or Bacteriological Strategy Using Nonbronchoscopic mentioning

confidence: 99%

Diagnosis and treatment of nosocomial pneumonia in ALI/ARDS patients

Fagon

Chastre²

2003

European Respiratory Journal

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Diagnosis and treatment of nosocomial pneumonia in ALI/ARDS patients. J-Y. Fagon, J. Chastre. #ERS Journals Ltd 2003. ABSTRACT: Ventilator-associated pneumonia (VAP) is a common complication of the acute respiratory distress syndrome (ARDS) or acute lung injury (ALI), often leading to the development of sepsis, multiple organ failure, and death. However, the diagnosis of pulmonary infection in patients with ARDS/ALI is often difficult: the systemic signs of infection, such as fever, tachycardia, leukocytosis are nonspecific findings in such patients; a variety of causes other than pneumonia can explain asymmetric consolidation in patients with ARDS and marked asymmetry of radiographic abnormalities has also been reported in patients with uncomplicated ARDS.In 2003, physicians in charge of these patients have to identify patients with true bacterial lung infection, to select appropriate initial antibiotic therapy, to adjust therapy as soon as possible, and to withhold antibiotics in patients without VAP. To do that, a bacteriological strategy based on the use of quantitative cultures of specimen obtained with fibreoptic bronchoscopy performed before initiation or modification of antibiotic treatment seems better than a strategy based on clinical evaluation alone, lowering antibiotic consumption and improving outcome. When bronchoscopy is not available or contraindicated, a nonbronchoscopic strategy or a clinical strategy with reevaluation 3 days after initiation of treatment may be used.Antimicrobial treatment of VAP is a complex issue. Some general principles can be helpful for the selection of initial treatment: knowledge of most frequently identified responsible pathogens and their susceptibility patterns in the unit; prior duration of hospitalisation; previously prescribed antibiotics; information obtained by direct examination of pulmonary secretions; antibacterial activity and pharmacodynamic characteristics of antibiotics that could be used to treat this infection.Appropriateness of initial antimicrobial therapy is probably a major prognostic factor for patients with ventilator-associated pneumonia. Thus, before new antiboitics are administered, reliable pulmonary specimens must be obtained for direct examination and cultures.

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Diagnosis and Treatment of Ventilator-Associated Pneumonia—Impact on Survival

Cited by 61 publications

References 43 publications

Ventilator-Associated Pneumonia

Ventilator-Associated Pneumonia

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

Diagnosis and treatment of nosocomial pneumonia in ALI/ARDS patients

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