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Evidence-Based Assessment of Diagnostic Tests for Ventilator-Associated Pneumonia*: Executive Summary

Ronald F. Grossman, MD, FCCP; Alan Fein, MD, FCCP
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*From Mount Sinai Hospital (Dr. Grossman), Toronto, Canada; and North Shore University Hospital (Dr. Fein), Manhassett, NY.

Correspondence to: Ronald F. Grossman, MD, FCCP, Mount Sinai Hospital, Suite 640, 600 University Ave, Toronto, Ontario, Canada M5G 1X5; e-mail: ronaldf.grossman@utoronto.ca



Chest. 2000;117(4_suppl_2):177S-181S. doi:10.1378/chest.117.4_suppl_2.177S
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Ventilator-associated pneumonia (VAP) is difficult to diagnose, and the precise role of invasive testing is controversial. Confronted with a changing clinical or radiographic setting demanding specific therapy, clinicians increasingly use invasive testing to supplement their clinical judgment. Invasive techniques include the protected-specimen brush (PSB) technique and BAL.

The PSB technique was developed in 1987 by Wimberly et al1 and has since been improved. Because it was found that samples may become contaminated by organisms of the upper airway, methods have been advanced to protect the sampling fluid. In addition, quantitative culture methods have been developed to permit distinguishing infection from colonization. However, because of concerns about diagnostic accuracy, reproducibility of results, diagnostic thresholds, nonstandardized methodology, and lack of data on clinical outcome, few definitive recommendations have been reached.2,3

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