Chest
clinical investigations in critical careThe Diagnosis of Ventilator-Associated Pneumonia: A Comparison of Histologic, Microbiologic, and Clinical Criteria
Section snippets
Study Design
The study, a prospective cross-sectional study of 40 patients dying while receiving mechanical ventilation, was approved by our institutional review committee on human research.
Patient Population
The patients were recruited from the combined medical and surgical ICU of a 234-bed teaching hospital. The criteria for inclusion were as follows: (1) the patient had >24 h of mechanical ventilation prior to death; (2) the patient had been hospitalized for ≥72 h prior to death; and (3) specimen collection could be
Results
From August 1991 to October 1994, 40 patients were prospectively entered. The pathology specimen from one patient was lost in the course of the study and the related data were excluded from analysis. The study group of 39 patients consisted of 20 women and 19 men with a mean age of 66 years (range, 38 to 85 years). The duration of mechanical ventilation ranged from 1 to 134 days with a mean of 14 days and median of 8 days. Thirty-six of 39 patients had airspace disease on the chest radiograph
Discussion
The diagnosis of pneumonia in the ventilated patient remains elusive. Chastre and colleagues8 in 1984 were the first to use postmortem lung biopsy specimens for validation of the diagnosis of pneumonia, comparing histologic features with results from quantitative culture of lung parenchyma and an FOB-guided PSB of distal airway secretions. Twenty-six patients ventilated for a mean 11 days were studied, 14 of whom were receiving antibiotics. The lung biopsy specimen consisted of six 5-mm3
ACKNOWLEDGMENT
The authors gratefully acknowledge Donald E. Johnson, MT (ASCP), for performing the bacteriology, Ingrid M. Peterson, MD, for her radiologic review, Rae Wu, MD, MPH, for her statistical analysis, and Jane Lopez for her superb assistance in manuscript preparation and editing.
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This work was funded by the Edward H. Morgan Fund for Clinical Research in Pulmonary Disease, Virginia Mason Research Center, Seattle.