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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,036

Periodicità: Mensile

ISSN 0375-9393

Online ISSN 1827-1596


Minerva Anestesiologica 2009 Ottobre;75(10):584-90


Ventilator associated pneumonia (VAP): An Impossible Diagnosis? Call for a pragmatic approach

Langer M. 1,2, Haeusler E. A. 2

1 Department of Anesthesiology, Intensive Care and Dermatology, University of Milan, Milan, Italy;
2 Department of Anesthesiology, Resuscitation, Pain Therapy, Palliative Care and Clinical Nutrition, IRCCS National Cancer Institute, Milan, Italy

Many years after the introduction of the protected specimen brush (PSB) by Wimberley et al. as a tool to diagnose ventilator associated pneumonia (VAP), new sampling techniques have increased the controversy concerning the diagnosis of VAP. Agreement exists only on the high sensibility and low specificity of the clinical symptoms combined with imaging data. However, sampling methods, qualitative/quantitative microbiological evaluation and the value of “markers” still appear to be unresolved issues. Because a proven diagnosis is very rare, a more pragmatic approach to VAP diagnosis seems necessary. More specifically, the questions we must focus on include the following: ”Which patients with possible pneumonia or lower respiratory infection require antibiotic treatment ?” and “In which patients with possible/suspected VAP is empiric treatment not immediately necessary and for which of these patients can empiric treatment be limited or discontinued?”

lingua: Inglese


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