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Clinical Investigations in Critical CareReappraisal of Distal Diagnostic Testing in the Diagnosis of ICU-Acquired Pneumonia
Section snippets
Methods
Between March 1990 and December 1992, we performed serially PSB, PTC, BAL D, and BAL C on consecutive patients with suspected IAP and evaluated the diagnostic value of each procedure and its best threshold.
Patients
During the study period, 663 patients were admitted to the ICU. Four hundred eighteen patients (63%) were mechanically ventilated for more than 2 days. IAP was suspected in 122 patients who were enrolled into the study. Reasons for ICU admission are summarized in Table 1. Patients had been receiving mechanical ventilation for 13.2±10 days prior to suspicion of IAP. Forty-nine (40%) of these patients fulfilled criteria for diagnosis of ARDS and 39 (32%) patients had a history of preexisting
Discussion
Our ICU patient population was quite similar to those previously studied.3,4 The high ratio of patients with COPD,20 with ABDS,20, 21, 22 and with previous antibiotic therapy during the ICU stay1,4,23, 24 was presumed to decrease the diagnostic value of bacteriologic samples and partly explains modest sensitivity and specificity results using classic thresholds. However, the diagnostic value of each procedure is similar to those previously reported.1–3,0,0,9,23,24 The best results were obtained
Acknowledgment
We thank J.Y. Fagon (Paris) and W.G. Johanson (Newark) for their advice and review of the manuscript; Melanie Christensen for her technical help in writing this manuscript; and Eric Roupie, MD, André Cabie, MD, and Bertrand Renaud for active participation in the study.
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