0
Editorials |

Is There a Role for Routine Surveillance Endotracheal Aspirate Cultures in the Treatment of BAL-Confirmed Ventilator-Associated Pneumonia?

Cherdchai Nopmaneejumruslers, MD; Charles K.N. Chan, MD, FCCP
Author and Funding Information

Affiliations: Toronto, ON, Canada
 ,  Dr. Nopmaneejumruslers is a senior Pulmonary Fellow, University of Toronto. Dr. Chan is Associate Professor of Medicine, Head, Joint Division of Respirology, University Health Network & Mt. Sinai Hospital.

Correspondence to: Charles K.N. Chan, MD, FCCP, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G2N2; e-mail: charles.chan@uhn.on.ca



Chest. 2005;127(2):425-427. doi:10.1378/chest.127.2.425
Text Size: A A A
Published online

Extract

Ventilator-associated pneumonia (VAP) is the major cause of infection in critically ill patients who are receiving mechanical ventilation, with a prevalence of 8 to 28%,12 and is one of the leading causes of death from hospital-acquired infections in critical care units.3 VAP is also associated with prolonged hospitalization and increased health-care costs.4 There is no doubt that the diagnosis of VAP remains one of the most controversial and challenging topics in the management of patients receiving mechanical ventilation.5 In general, the most acceptable standards for the diagnosis of VAP require quantitative cultures of BAL fluid or protected specimen brush (PSB) samples.67 Using 106 cfu/mL as the interpretative cutoff point for respiratory secretion cultures from endotracheal aspirates (EAs) has a comparable accuracy compared to that with the PSB technique, with a higher sensitivity (82%) and a lower specificity (83%).9 However, as soon as a lower threshold is used, specificity declined significantly. Irrespective of which standard is chosen, there is still an inherent delay from the time the BAL fluid, PSB, or EA specimen was obtained to the availability of the culture reports. In practice, patients who are suspected to have VAP would be started on empiric therapy pending culture results.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543