Invasive techniques in the diagnosis of bacterial pneumonia in the intensive care unit.

Bacterial nosocomial pneumonia represents the greatest infectious risk for morbidity and mortality for patients requiring intensive care and mechanical ventilation. The occurrence of purulent respiratory secretions and new infiltrates on chest radiograph generally necessitates broad-spectrum antibiotic therapy due to the lack of a safe, reliable method of determining the presence or absence of bacterial pneumonia. This article reviews the currently available invasive techniques for the diagnosis of bacterial pneumonia in the intensive care patient, with particular emphasis on the bronchoscopic methods using protected specimen brushes and bronchoalveolar lavage. The reliability, risks, and techniques of the various procedures are compared and contrasted.