Study objectives: To review the various methods used to diagnose lower respiratory tract infections.
Design: Review of literature with appropriate references to various techniques proposed to diagnose pneumonia.
Intervention: Compare and contrast different proposed approaches to diagnose pneumonia.
Results: Bronchoscopic techniques appear more clear cut for certain nonbacterial pathogens. Their role in immunocompromised patients is more clear cut, while in the nonimmunocompromised patient, invasive diagnostic techniques probably provide a higher certainty of the final diagnosis of the patient. Recent interest has focused on nonbronchoscopic techniques for the mechanically ventilated patient. None of these techniques has been demonstrated to change clinical outcome.
Conclusions: Diagnosis of lower respiratory tract infection has to be tailored for the individual patient. Decision about which procedure to do is influenced by the patient's underlying immune status, level of illness, and response to empiric therapy.