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Determinants of outcome in patients with a clinical suspicion of ventilator-associated pneumonia.

Abstract：

INTRODUCTION:In the absence of a reference standard, a probabilistic approach to the diagnosis of ventilator-associated pneumonia (VAP) has been proposed; and clinician judgment augmented by microbiological tests is used to guide therapy for patients having a clinical suspicion of VAP (CSVAP). However, the correlation of both clinician judgment at the time of CSVAP and the probability of VAP with clinical outcomes is unknown. In a cohort of patients with CSVAP, we sought to determine the correlation of clinician judgment and the probability of VAP with clinical outcomes. In addition, we studied the impact of the clinical and microbiological components of CSVAP on the processes of care and outcomes. METHODS:We performed a retrospective analysis of data from a multicenter, randomized trial in 740 patients with CSVAP. Prospective clinician judgment of VAP probability at the time of CSVAP and retrospective adjudication of VAP were compared with clinical outcomes. The following determinants of CSVAP on outcomes were studied: time of CSVAP, index culture results, and the presence of bacteremia. RESULTS:Neither clinician index of suspicion for VAP nor retrospective adjudication of VAP correlated with clinical outcomes. For CSVAP, occurrence >7 days after start of mechanical ventilation and negative index cultures were associated with worse outcomes. Bacteremia was associated with the development of increased organ dysfunction. CONCLUSION:In patients with CSVAP, clinician judgment as to the probability of VAP does not correlate with processes of care and outcomes; and its use to group patients into those with and without VAP is of limited clinical utility.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Muscedere JG,McColl C,Shorr A,Jiang X,Marshall J,Heyland DK,Canadian Critical Care Trials Group.

doi

10.1016/j.jcrc.2007.12.007

subject

Has Abstract

pub_date

2008-03-01 00:00:00

pages

41-9

issue

1

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(08)00008-7

journal_volume

23

pub_type

杂志文章,多中心研究,随机对照试验

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