Reports From The Field-Pulmonary care
Reports From The Field-Pulmonary care
Aggressive approach cuts antibiotic use
Improving outcomes for vent-related pneumonia
An invasive test that requires physicians to insert a bronchoscope into the respiratory tract may well be worth the risk and costs associated with the procedure, according to a recent study in the Annals of Internal Medicine. The test allows physicians to obtain fluid and tissue samples from the lungs of patients with suspected cases of ventilator-associated pneumonia.
Some pulmonologists have long advocated the use of invasive tests to diagnose suspected cases of ventilator-associated pneumonia. However, no studies have proven that the procedure improves patient outcomes.
Researchers studied 413 patients in 31 intensive care units in France with suspected cases of ventilator-associated pneumonia. Some patients received the invasive test, and others were diagnosed and treated on the basis of clinical findings alone. Researchers followed the patients to see who died or developed blood clotting or complications involving the heart, lungs, kidneys, nervous system, or liver. They also measured antibiotic use at 14 and 28 days.
After accounting for baseline differences in patients receiving the invasive test and patients not receiving the test, researchers found that patients who underwent invasive tests were less likely than those in the clinical findings group to have died or suffered organ failure at 14 days. The advantage of using the invasive approach was less clear at 28 days, but the patients who had invasive tests still had better overall outcomes. For example, the invasive strategy group had fewer overall antibiotic days than the clinical findings group.
Researchers concluded that patients who undergo invasive tests to diagnose and manage suspected ventilator-associated pneumonia do better and spend fewer days taking antibiotics than patients in whom the diagnosis and management is guided by clinical findings.
[See: Fagon JY, Chastre J, Wolff M, et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia: A randomized trial. Ann Intern Med 2000; 132:621-630.]
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