Abstract
The management of patients suspected of having ventilator-associated pneumonia (VAP) requires a strategy for diagnosis and treatment that is designated to: (1) identify patients with true lung bacterial infection; (2) determine the pathogen(s) responsible for pneumonia; (3) permit early selection of appropriate antimicrobial therapy; and (4) avoid indiscriminate administration of antibiotics. The use of bronchoscopic techniques to obtain bronchoalveolar lavage (BAL) specimens from the affected area in the lung allows definition of a strategy superior to that based exclusively on clinical evaluation. When BAL is performed before introduction of new antibiotics, it enables physicians to identify patients who need immediate treatment and help to select initial antibiotic therapy (with the results of direct examination of BAL liquid) and to withhold, deescalate, and/or optimize treatment (when the results of quantitative cultures are available), in a manner that is safe and well tolerated by patients. This strategy, based on clinical and bacteriological evaluation, prevents resorting to broad-spectrum drug coverage in all patients who develop signs and symptoms suggestive of pneumonia, thus minimizing the emergence of resistant flo...Continue Reading
Citations
Jun 6, 2007·Intensive Care Medicine·Elpis GiantsouKonstantinos Manolas
Dec 18, 2012·Surgical Infections·Mark A JonkerKenneth A Kudsk
Feb 13, 2009·Journal of Paediatrics and Child Health·Brenda M Morrow, Andrew C Argent
May 21, 2014·Surgical Infections·Christopher A GuidryRobert G Sawyer
Dec 24, 2011·Medicina intensiva·A Estella
Oct 18, 2011·Medicina intensiva·A Estella, F Alvarez-Lerma
Nov 27, 2015·Scientific Reports·Ronny SchnabelFrederik Jan van Schooten
Oct 7, 2015·Respiratory Medicine·R M SchnabelD C J J Bergmans
Oct 28, 2008·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Richard J WallJayant K Deshpande
Oct 1, 2015·BMC Pulmonary Medicine·R M SchnabelD C J J Bergmans
Jun 22, 2007·Critical Care Medicine·Alberto Corona
Apr 7, 2007·Current Opinion in Pulmonary Medicine·Graciela J Soto
Sep 7, 2018·Canadian Respiratory Journal : Journal of the Canadian Thoracic Society·Gustavo RochaHercília Guimarães
Dec 13, 2018·BMC Anesthesiology·Yongtao GaoSiyuan Liu
Oct 8, 2020·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Roberto LorussoDavid A D'Alessandro
Oct 7, 2020·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Roberto LorussoDavid A D'Alessandro
Nov 4, 2020·Antimicrobial Agents and Chemotherapy·Marco M CustodioRenee-Claude Mercier
Oct 12, 2020·The Journal of Thoracic and Cardiovascular Surgery·Roberto LorussoDavid A D'Alessandro
Nov 10, 2021·Journal of Veterinary Internal Medicine·Jennifer HowardMegan Grobman