Abstract
Although mechanical ventilation is instituted as a life-saving technique, it may lead to complications that can negatively impact on patients' morbidity and/or mortality. Ventilator associated pneumonia (VAP) is one such complication that is a common challenge to intensivists. Although most experts would agree that early 'appropriate' antibiotic use is essential in patients who develop VAP, the best diagnostic test to guide decision-making is far from clear. One diagnostic test that is capable of providing microbiological samples from the lower respiratory tree is invasive bronchoscopy with a protected specimen brush. Such a procedure has long been available to intensivists and is frequently employed in many intensive care units. However, this procedure has associated costs and potential complications, and its utility in VAP has been challenged. In this issue of Critical Care Forum, the two sides of this debate are brought forward with compelling arguments. The authors' arguments should fuel future trials.
Highlights
A 50-year-old man has been in your intensive care unit (ICU) for 10 days
A question still remains: Does a management strategy that incorporates the results from invasive diagnostic tests lead to important differences in patient management and improved outcomes compared with results from endotracheal aspirates? This important question cannot be answered without examining issues related to antibiotic use
For a patient with Ventilator associated pneumonia (VAP), what is probably more important to the final outcome than the diagnostic test is the use of BAL = broncho-alveolar lavage; ICU = intensive care unit; PSB = protected specimen brush; VAP = ventilator associated pneumonia
Summary
A 50-year-old man has been in your intensive care unit (ICU) for 10 days. He was initially admitted with respiratory failure secondary to congestive heart failure. A question still remains: Does a management strategy that incorporates the results from invasive diagnostic tests lead to important differences in patient management and improved outcomes compared with results from endotracheal aspirates? For a patient with VAP, what is probably more important to the final outcome than the diagnostic test is the use of BAL = broncho-alveolar lavage; ICU = intensive care unit; PSB = protected specimen brush; VAP = ventilator associated pneumonia..
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