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Critical Care

, 12:R56

First Online: 21 April 2008Received: 02 February 2008Revised: 01 April 2008Accepted: 21 April 2008

Abstract

IntroductionEarly, accurate diagnosis is fundamental in the management of patients with ventilator-associated pneumonia VAP. The aim of this qualitative review was to compare various criteria of diagnosing VAP in the intensive care unit ICU with a special emphasis on the value of clinical diagnosis, microbiological culture techniques, and biomarkers of host response.

MethodsA MEDLINE search was performed using the keyword -ventilator associated pneumonia- AND -diagnosis-. Our search was limited to human studies published between January 1966 and June 2007. Only studies of at least 25 adult patients were included. Predefined variables were collected, including year of publication, study design prospective-retrospective, number of patients included, and disease group.

ResultsOf 572 articles fulfilling the initial search criteria, 159 articles were chosen for detailed review of the full text. A total of 64 articles fulfilled the inclusion criteria and were included in our review. Clinical criteria, used in combination, may be helpful in diagnosing VAP, however, the considerable inter-observer variability and the moderate performance should be taken in account. 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, including inflammatory cells and Gram stains, may be useful in initial therapeutic decisions in patients with suspected VAP. C-reactive protein, procalcitonin, and soluble triggering receptor expressed on myeloid cells are promising biomarkers in diagnosing VAP.

ConclusionAn 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.

AbbreviationsARDSAcute respiratory distress syndrome

BALBronchoalveolar lavage

CFUColony forming units

CPISClinical pulmonary infection score

CRPC-reactive protein

EFElastin fiber

ICUIntensive care unit

NNISNational Nosocomial Infection Surveillance

pBALProtected bronchoalvolar lavage

PCTProcalcitonin

PSBProtected specimen brush

SIRSSystemic inflammatory response syndrome

VASTREMCSoluble triggering receptor expressed on myeloid cells

sTREMTBA = Tracheobronchial aspirate

VAPVentilator-associated pneumonia.

Electronic supplementary materialThe online version of this article doi:10.1186-cc6877 contains supplementary material, which is available to authorized users.

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Autor: Alvaro Rea-Neto - Nazah Cherif M Youssef - Fabio Tuche - Frank Brunkhorst - V Marco Ranieri - Konrad Reinhart - Yasser S

Fuente: https://link.springer.com/







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