The fickle fingerprint of fate

Sleep deprivation is amongst the many reasons why your editors are glad they are not intensivists, but diagnostic impossibility is another one. The ventilated patient who is deteriorating, who may or may not have a new pulmonary infiltrate, which may or may not be due to pulmonary oedema, atelectasis, haemorrhage, infection or other reasons presents a huge diagnostic challenge—is it ventilator associated pneumonia, and how to confirm it, given any sampling procedure has to traverse a likely heavily infected endotracheal tube and trachea? The penalty of not treating may be death of the patient, and the penalty of giving out potent broad spectrum antibiotics is resistant organisms, the front page of the Daily Mail, and now being reported to the GMC. Fowler and colleagues (see page 320, Hot topic) report that a high lower airway pathogen load has a fingerprint in breath samples analysed for volatiles by thermal desorption/gas chromatography/time-of-flight mass spectrometry (or a highly expensive and sophisticated toy to you). Still preliminary, and …