In the first option, quantitative procedures include nonbronchoscopic
techniques (quantitative endotracheal aspiration, BBS, mini-BAL, or
BPSB) and bronchoscopic techniques (BAL, PSB, or protected BAL).
Because these tests have similar sensitivities, specificities, positive
predictive values, and likelihood ratios, the choice depends on local
expertise, experience, availability, and cost factors (grade D
recommendation). Treatment should be based on the results of diagnostic
testing. Decisions about empirical therapy should be determined by the
patient’s clinical stability, the degree of clinical suspicion, and
the results of preliminary tests.