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. 2014 Dec 16;1(1):e000066.
doi: 10.1136/bmjresp-2014-000066. eCollection 2014.

A national survey of the diagnosis and management of suspected ventilator-associated pneumonia

Emma Browne  1 , Thomas P Hellyer  1 , Simon V Baudouin  1 , Andrew Conway Morris  2 , Vanessa Linnett  3 , Danny F McAuley  4 , Gavin D Perkins  5 , A John Simpson  1
Affiliations

A national survey of the diagnosis and management of suspected ventilator-associated pneumonia

Emma Browne et al. BMJ Open Respir Res. .

Abstract

Background: Ventilator-associated pneumonia (VAP) affects up to 20% of patients admitted to intensive care units (ICU). It is associated with increased morbidity, mortality and healthcare costs. Despite published guidelines, variability in diagnosis and management exists, the extent of which remains unclear. We sought to characterise consultant opinions surrounding diagnostic and management practice for VAP in the UK.

Methods: An online survey was sent to all consultant members of the UK Intensive Care Society (n=∼1500). Data were collected regarding respondents' individual practice in the investigation and management of suspected VAP including use of diagnostic criteria, microbiological sampling, chest X-ray (CXR), bronchoscopy and antibiotic treatments.

Results: 339 (23%) responses were received from a broadly representative spectrum of ICU consultants. All respondents indicated that microbiological confirmation should be sought, the majority (57.8%) stating they would take an endotracheal aspirate prior to starting empirical antibiotics. Microbiology reporting services were described as qualitative only by 29.7%. Only 17% of respondents had access to routine reporting of CXRs by a radiologist. Little consensus exists regarding technique for bronchoalveolar lavage (BAL) with the reported volume of saline used ranging from 5 to 500 mL. 24.5% of consultants felt inadequately trained in bronchoscopy.

Conclusions: There is wide variability in the approach to diagnosis and management of VAP among UK consultants. Such variability challenges the reliability of the diagnosis of VAP and its reported incidence as a performance indicator in healthcare systems. The data presented suggest increased radiological and microbiological support, and standardisation of BAL technique, might improve this situation.

Keywords: Assisted Ventilation; Pneumonia; Respiratory Infection.

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Figures

Figure 1
Figure 1
Mean case load within respondent's intensive care unit.
Figure 2
Figure 2
Recognised criteria for diagnosis of ventilator-associated pneumonia (CXR, chest X-ray).
Figure 3
Figure 3
Current practice when suspecting a diagnosis of ventilator-associated pneumonia (abx, antibiotics; ETA, endotracheal aspirate; BAL, bronchoalveolar lavage; PSB, protected specimen brush).
Figure 4
Figure 4
Availability of microbiology services within respondents’ hospitals.
Figure 5
Figure 5
Level of reporting of chest X-rays on the intensive care unit.
Figure 6
Figure 6
Reported empirical antibiotic selection in cases of suspected ventilator-associated pneumonia.
See this image and copyright information in PMC

References

    1. Rello J, Ollendorf DA, Oster G et al. . Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:2115–21. - PubMed
    1. Kollef M. Ventilator-associated pneumonia: a multivariate analysis. JAMA 1993;270:1965–70. - PubMed
    1. Chastre J, Fagon JY. State of the Art: ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867–903. - PubMed
    1. Klein Klouwenberg PMC, van Mourik MSM, Ong DSY et al. . Electronic implementation of a novel surveillance paradigm for ventilator-associated events: feasibility and validation. Am J Respir Crit Care Med 2014;189:947–55. - PubMed
    1. Safdar N, Dezfulian C, Collard HR et al. . Clinical and economic consequences of ventilator-associated pneumonia—a systematic review. Crit Care Med 2005;33:2184–93. - PubMed

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