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.