Chest
Volume 117, Issue 4, Supplement 2, April 2000, Pages 195S-197S
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Endotracheal Aspiration in the Diagnosis of Ventilator-Associated Pneumonia

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Analysis

The most acceptable reference standards or “gold standards” usually include biopsy or autopsy reports. Since these often are not feasible standards, alternatives are usually used. They include cultures of pleural and blood specimens, long-term follow-up to exclude other diagnoses, and quantitative cultures of specimens obtained through bronchoscopic techniques. The use of bronchoscopic specimens makes interpretation of the reference standard particularly difficult, since the test properties of

Results

The comprehensive literature search described earlier2 yielded 12 relevant citations2,13–15,18,23,91–96 published from 1985 to 1995. Nine studies evaluated cultures from EA, two studies evaluated antibody coating, and three studies evaluated elastin fibers. Study characteristics and the results of Gram's stain and aspiration culture appear in Table 9. The same data are recorded for antibody coating in Table 10, and for elastin fibers in Table 11. The original articles present the details of the

Conclusions

  • The sensitivity and specificity of quantitative tests on cultures of EA samples vary widely in their ability to diagnose VAP.

  • Qualitative EA cultures usually identify organisms found by invasive tests (EA cultures have high sensitivity). However, qualitative EA cultures often recover multiple organisms, including nonpathogens (EA tests have a moderate positive-predictive value). If the result of a qualitative EA culture is negative, VAP is unlikely unless the patient has received antibiotic

Recommendations

Current studies on VAP diagnosis evaluate the most basic, frequently used approaches to endotracheal analysis and yield insufficient data to generate strong clinical policy recommendations (recommendations based on research). Fewer than 600 patients contribute to the body of evidence. More high-quality studies are needed.

Although the studies reviewed in this report are moderately rigorous, differences between studies in designs and results make generalizations difficult. For example, in studies

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