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Blinded Invasive Diagnostic Procedures in Ventilator-Associated Pneumonia*

G. Douglas Campbell, Jr., MD, FCCP
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*From the Division of Pulmonary and Critical Care Medicine, Louisiana State University Medical Center, Shreveport, LA.



Chest. 2000;117(4_suppl_2):207S-211S. doi:10.1378/chest.117.4_suppl_2.207S
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Because invasive diagnostic testing using fiberoptic bronchoscopy (FOB) is associated with inconvenience, expense, the need for operator expertise, and potential side effects, other methods have been developed for taking samples from the lower respiratory tract of patients suspected of having ventilator-associated pneumonia. As with other methods, issues of sensitivity and specificity arise because of the difficulty of accurately diagnosing pneumonia.

This section reviews 15 studies evaluating the accuracy of blinded sampling methods.20,30,31,37,45,84,93,119–126 The studies were performed in patients receiving mechanical ventilation in various types of ICUs. Included are small numbers of patients with community-acquired pneumonia who require ventilator support, as well as a few immunocompromised patients. These studies investigated 654 episodes of pneumonia, most of which were thought to be pneumonia on a clinical basis. Of these 654 episodes, 321 were identified as pneumonia using a variety of different methods.

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