Diagnosis and treatment of ventilator-associated pneumonia: fiberoptic bronchoscopy with bronchoalveolar lavage is essential

Seminars in Respiratory and Critical Care Medicine
Jean-Yves Fagon

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
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
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
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
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

❮ Previous
Next ❯

Related Concepts

Related Feeds

Bacterial Pneumonia

Bacterial pneumonia is a prevalent and costly infection that is a significant cause of morbidity and mortality in patients of all ages. Here is the latest research.

Bacterial Pneumonia (ASM)

Bacterial pneumonia is a prevalent and costly infection that is a significant cause of morbidity and mortality in patients of all ages. Here is the latest research.

Antifungals (ASM)

An antifungal, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis, cryptococcal meningitis, and others. Discover the latest research on antifungals here.

Antifungals

An antifungal, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis, cryptococcal meningitis, and others. Discover the latest research on antifungals here.