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Clinical Criteria in the Diagnosis of Ventilator-Associated Pneumonia*

Richard G. Wunderink, MD, FCCP
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*From the Department of Pulmonary and Critical Care Research, Methodist Hospitals of Memphis, Memphis, TN.



Chest. 2000;117(4_suppl_2):191S-194S. doi:10.1378/chest.117.4_suppl_2.191S
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This section discusses the accuracy of the traditional clinical criteria of fever, leukocytosis, and purulent tracheal secretions, usually with abnormal radiographic signs, as initial possible indicators of ventilator-associated pneumonia (VAP).

A major methodological problem in assessing the sensitivity or specificity of these clinical criteria is obtaining the correct denominator. Instead of providing the total number of patients at risk, many studies give only the number who met at least one criterion or the number who gave a subjective clinical impression of being at risk for VAP. Therefore, sensitivities may be lower and specificities higher if data from these studies are applied to the entire population of ventilator-assisted patients.

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