Diagnosis of ventilator associated pneumonia, to invade or not?

Excerpt

Ventilator-associated pneumonia (VAP) prolongs intensive care unit (ICU) length of stay and increases the risk of death in critically ill patients. A presumptive diagnosis is often made when a patient on a ventilator develops new radiographically detected infiltrates with signs of new sepsis. One can adopt a noninvasive strategy of treatment based on endotracheal aspirates; however, this may lead to overestimation of VAP. This study compares a non invasive strategy with an invasive approach using scrupulous bronchoscopy based collection of specimens using bronchoalveolar lavage (BAL) or protected specimen brush sample (PSBS) and quantitative cultures. In both groups, antibiotics were held either until a Gram stain was positive or if they had signs of severe sepsis. The antibiotic choice was the same (ATS guideline - additional comment below); the only difference was the sampling technique prior to antibiotic use, ie endotracheal sample or bronchoscopic sample. …