Diagnosing ventilator-associated pneumonia

The role of bronchoscopy

R. M. Allen, W. F. Dunn, Andrew Harold Limper

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective: To discuss the two diagnostic procedures used most frequently to obtain uncontaminated lower airway secretions during bronchoscopy. Design: This article reviews the contributing risk factors of ventilator-associated pneumonia (VAP) and the recent studies that have assessed the usefulness of the protected specimen brush (PSB) and bronchoalveolar lavage (BAL) in the nonimmunocompromised host. Results: A prompt, accurate diagnosis of VAP, including specific identification of the bacterial pathogen, remains a common challenge in the intensive-care unit. Standard clinical criteria are of suboptimal specificity for making decisions, including selecting antibiotic therapy. Bronchoscopic techniques of lung secretion sampling can be used in the intensive-care unit in an effort to overcome the effects of oropharyngeal contamination. The PSB and BAL, used appropriately, can help intensive-care clinicians formulate specific antimicrobial therapy. Evaluation of intracellular bacteria obtained by BAL has been reported to be useful in guiding empiric antibiotic therapy while the final results of cultures obtained with the PSB are pending. Prior antibiotic therapy, however, may confound the interpretation and clinical utility of results. Conclusion: Currently, for a patient taking antibiotic therapy, no reliable technique nor quantitative culture threshold exists to help in diagnosing suspected VAP or in guiding antibiotic therapy. If the clinical situation allows, antibiotic therapy should be discontinued for 48 hours; then, the PSB, BAL, protected BAL, or endobronchial aspiration should be used. These contemporary modalities, however, necessitate further clinical trials before widespread use is warranted.

Original languageEnglish (US)
Pages (from-to)962-968
Number of pages7
JournalMayo Clinic Proceedings
Volume69
Issue number10
StatePublished - 1994

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Ventilator-Associated Pneumonia
Bronchoscopy
Bronchoalveolar Lavage
Anti-Bacterial Agents
Therapeutics
Intensive Care Units
Critical Care
Decision Making
Clinical Trials
Bacteria
Lung

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Diagnosing ventilator-associated pneumonia : The role of bronchoscopy. / Allen, R. M.; Dunn, W. F.; Limper, Andrew Harold.

In: Mayo Clinic Proceedings, Vol. 69, No. 10, 1994, p. 962-968.

Research output: Contribution to journalArticle

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