Diagnosis of ventilator-associated pneumonia: an evaluation of direct examination and presence of intracellular organisms.

Abstract:

BACKGROUND:Ventilator-associated pneumonia (VAP) requires early diagnosis and adequate antibiotic therapy. The aim of this prospective postmortem study was to assess the accuracy of direct examination and quantification of intracellular organisms (ICO) for the diagnosis of VAP. METHODS:Total and differential cell counts were performed on fluids recovered using nonbronchoscopic sampling techniques (blind bronchial sampling [BBS], mini-bronchoalveolar lavage [mini-BAL]) and from bronchoalveolar lavage (BAL) performed during fiberscopy. These 3 sampling techniques were done within 15 min of death without discontinuing mechanical ventilation. Quantification of ICO was performed on each sample recovered from the various sampling procedures. Gram reaction and morphology of bacteria were evaluated on Gram smears. RESULTS:The results of each technique were compared with histology and culture of lung tissue specimens obtained by surgical pneumonectomies in 28 patients who died after at least 72 h of mechanical ventilation. Histology was positive in 13 patients and negative in 15 patients. When only VAP with positive lung culture was considered (histologic signs of bronchopneumonia plus positive lung tissue culture), the sensitivity of Gram staining on BAL, mini-BAL, and BBS was 56%, 44%, and 56%, respectively. If all samples were considered, the sensitivity and the specificity of the determination of the percentage of ICO were low (less than 70%) whatever the sampling technique. CONCLUSIONS:For initial therapeutic guidance, direct examination and presence of ICO do not contribute for establishing the diagnosis of VAP, essentially because of a lack of sensitivity. However, when positive, Gram staining can obviously guide initial antibiotherapy.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Papazian L,Autillo-Touati A,Thomas P,Bregeon F,Garbe L,Saux P,Seite R,Gouin F

doi

10.1097/00000542-199708000-00013

subject

Has Abstract

pub_date

1997-08-01 00:00:00

pages

268-76

issue

2

eissn

0003-3022

issn

1528-1175

journal_volume

87

pub_type

杂志文章
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    authors: Bleyl JU,Ragaller M,Tschö U,Regner M,Kanzow M,Hübler M,Rasche S,Albrecht M

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    authors: Yanez P,Martyn JA

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    journal_title:Anesthesiology

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    authors: Domino KB,Hlastala MP,Cheney FW

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  • Newborn blood levels of lidocaine and mepivacaine in the first postnatal day following maternal epidural anesthesia.

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    journal_title:Anesthesiology

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    authors: Brown WU,Bell GC,Lurie AO,Weiss B,Scanlon JW,Alper MH

    更新日期:1975-06-01 00:00:00

  • Electrocardiographic exercise stress testing for cardiac risk assessment in patients undergoing noncardiac surgery.

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    journal_title:Anesthesiology

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    doi:10.1097/00000542-200101000-00011

    authors: Gauss A,Röhm HJ,Schäuffelen A,Vogel T,Mohl U,Straehle A,Meierhenrich R,Georgieff M,Steinbach G,Schütz W

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  • Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death: A Substudy of the POISE-2 Trial.

    abstract:BACKGROUND:The relative contributions of intraoperative and postoperative hypotension to perioperative morbidity remain unclear. We determined the association between hypotension and a composite of 30-day myocardial infarction and death over three periods: (1) intraoperative, (2) remaining day of surgery, and (3) durin...

    journal_title:Anesthesiology

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1097/ALN.0000000000001985

    authors: Sessler DI,Meyhoff CS,Zimmerman NM,Mao G,Leslie K,Vásquez SM,Balaji P,Alvarez-Garcia J,Cavalcanti AB,Parlow JL,Rahate PV,Seeberger MD,Gossetti B,Walker SA,Premchand RK,Dahl RM,Duceppe E,Rodseth R,Botto F,Devereaux P

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  • Membrane disordering effects of anesthetics are enhanced by gangliosides.

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    pub_type: 杂志文章

    doi:10.1097/00000542-198502000-00003

    authors: Harris RA,Groh GI

    更新日期:1985-02-01 00:00:00

  • Onset of maximum neuromuscular block following succinylcholine or vecuronium in four age groups.

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    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199308000-00006

    authors: Koscielniak-Nielsen ZJ,Bevan JC,Popovic V,Baxter MR,Donati F,Bevan DR

    更新日期:1993-08-01 00:00:00

  • Positive end-expiratory pressure ventilation elicits increases in endogenously formed nitric oxide as detected in air exhaled by rabbits.

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    journal_title:Anesthesiology

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    doi:10.1097/00000542-199504000-00021

    authors: Persson MG,Lönnqvist PA,Gustafsson LE

    更新日期:1995-04-01 00:00:00

  • Effects of halothane on the sarcoplasmic reticulum Ca2+ stores and contractile proteins in rabbit pulmonary arteries.

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    更新日期:1998-04-01 00:00:00

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    doi:10.1097/00000542-199303000-00017

    authors: Tsuchida H,Namba H,Yamakage M,Fujita S,Notsuki E,Namiki A

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    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200009000-00026

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    更新日期:2000-09-01 00:00:00

  • Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery.

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    journal_title:Anesthesiology

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/ALN.0000000000002751

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  • Propofol suppresses macrophage functions and modulates mitochondrial membrane potential and cellular adenosine triphosphate synthesis.

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    journal_title:Anesthesiology

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  • Intraoperative systolic blood pressure variability predicts 30-day mortality in aortocoronary bypass surgery patients.

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  • Involvement of cerulospinal glutamatergic neurotransmission in fentanyl-induced muscular rigidity in the rat.

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  • Effects of halothane and isoflurane on ventilation and occlusion pressure.

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    pub_type: 临床试验,杂志文章,随机对照试验

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    更新日期:1994-09-01 00:00:00

  • Functional studies of RYR1 mutations in the skeletal muscle ryanodine receptor using human RYR1 complementary DNA.

    abstract:BACKGROUND:Malignant hyperthermia is associated with mutations within the gene encoding the skeletal muscle ryanodine receptor, the calcium channel that releases Ca from sarcoplasmic reticulum stores triggering muscle contraction, and other metabolic activities. More than 200 variants have been identified in the ryanod...

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    doi:10.1097/ALN.0b013e3181d69283

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    更新日期:2010-06-01 00:00:00

  • Clinician-delivered intervention to facilitate tobacco quitline use by surgical patients.

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    journal_title:Anesthesiology

    pub_type: 杂志文章,随机对照试验

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  • A Phase 1, Dose-escalation, Double-blind, Block-randomized, Controlled Trial of Safety and Efficacy of Neosaxitoxin Alone and in Combination with 0.2% Bupivacaine, with and without Epinephrine, for Cutaneous Anesthesia.

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    journal_title:Anesthesiology

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/ALN.0000000000000831

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  • Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery.

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    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000000959

    authors: Kertai MD,Zhou S,Karhausen JA,Cooter M,Jooste E,Li YJ,White WD,Aronson S,Podgoreanu MV,Gaca J,Welsby IJ,Levy JH,Stafford-Smith M,Mathew JP,Fontes ML

    更新日期:2016-02-01 00:00:00

  • Pharmacokinetics and pharmacodynamics of rocuronium in patients with cirrhosis.

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    更新日期:1994-06-01 00:00:00

  • Monitoring of pulmonary endothelial enzyme function: an animal model for a simplified clinically applicable procedure.

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  • Improvement in oxygenation by phenylephrine and nitric oxide in patients with adult respiratory distress syndrome.

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    更新日期:1998-11-01 00:00:00

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  • Isoflurane activates sarcolemmal adenosine triphosphate-sensitive potassium channels in vascular smooth muscle cells: a role for protein kinase A.

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    pub_type: 杂志文章

    doi:10.1097/01.anes.0000265158.47556.73

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    更新日期:2007-05-01 00:00:00

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    pub_type: 杂志文章

    doi:10.1097/00000542-198509000-00008

    authors: Chauvin M,Bonnet F,Montembault C,Lafay M,Curet P,Viars P

    更新日期:1985-09-01 00:00:00