Nonbronchoscopic evaluation of ventilator-associated pneumonia.

The method to diagnose ventilator-associated pneumonia (VAP) ranges from physical examination to invasive procedures. In this section, the use of nonbronchoscopic techniques are reviewed. These include the traditional methods of reviewing the patient's clinical presentation and chest roentgenogram. Although these techniques are not specific, they are useful in helping the clinician in determining when to proceed with more tests to diagnose pneumonia. Methods for sampling lower respiratory tract secretions in an intubated patient include endotracheal aspirates as well as deeper samples obtained by protected brush or a nonbronchoscopic bronchoalveolar lavage catheter. Respiratory cultures can be useful in determining what is causing the pneumonia. However, the distinction between colonization and true infection is best understood if the samples are handled so that semiquantitative culture results can be reported. By using this approach, the physician should be able to better direct therapy and reduce mortality from pneumonia in the intensive care unit (ICU).