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Diagnosis of ventilator-associated pneumonia: controversies and working toward a gold standard
Philip E. Grguricha,b,c, Jana Hudcovab,d,e, Yuxiu Leib,f,g, Akmal Sarwarb,e,f,
and Donald E. Cravenb,e,g
Purpose of review
The aim is to discuss the clinical, microbiologic, and radiological criteria used in the diagnosis of ventilatorassociated pneumonia (VAP), distinguish between ventilator-associated tracheobronchitis (VAT) and VAP, and reconcile the proposed Centers for Disease Control surveillance criteria with clinical practice.
Recent findings
Numerous ventilator-associated complications (VACs), including VAP and VAT, may occur in critically ill, intubated patients. A variety of definitions for identifying VAP have been proposed, but there is no diagnostic gold standard. The proposed surveillance definition will identify infectious and noninfectious VAC, including VAP and VAT, but this definition may be inadequate for clinical practice.
Summary
The clinical characteristics of VAP and VAT are similar and include fever, leukocytosis, and purulent sputum. An infiltrate on chest radiograph is consistent with VAP but lacks diagnostic precision, so it is not a criterion in the proposed surveillance definition and should be interpreted cautiously by clinicians. Microbiologically, quantitative and semiquantitative endotracheal aspirate cultures may be employed to diagnose VAP and VAT. Positive bronchoalveolar lavage and protected specimen brush cultures are useful only for the diagnosis of VAP. Experts should collaborate to evelop consensus definitions for VAP and VAT that can be applied in practice.
Keywords
Centers for Disease Control surveillance definition, clinical diagnosis, multidrug resistant bacteria, ventilator-associated pneumonia, ventilator-associated tracheobronchitis
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发表于 2013-12-20 15:31:29
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