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Previous Volume 355:2619-2630 December 21, 2006 Number 25 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Kollef, M. H. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Critically ill patients who require mechanical ventilation are at risk for ventilator-associated pneumonia. Current data are conflicting as to the optimal diagnostic approach in patients who have suspected ventilator-associated pneumonia.

Methods In a multicenter trial, we randomly assigned immunocompetent adults who were receiving mechanical ventilation and who had suspected ventilator-associated pneumonia after 4 days in the intensive care unit (ICU) to undergo either bronchoalveolar lavage with quantitative culture of the bronchoalveolar-lavage fluid or endotracheal aspiration with nonquantitative culture of the aspirate. Patients known to be colonized or infected with pseudomonas species or methicillin-resistant Staphylococcus aureus were excluded. Empirical antibiotic therapy was initiated in all patients until culture results were available, at which point a protocol of targeted therapy was used for discontinuing or reducing the dose or number of antibiotics, or for resuming antibiotic therapy to treat a preenrollment condition if the culture was negative.

Results We enrolled 740 patients in 28 ICUs in Canada and the United States. There was no significant difference in the primary outcome (28-day mortality rate) between the bronchoalveolar-lavage group and the endotracheal-aspiration group (18.9% and 18.4%, respectively; P=0.94). The bronchoalveolar-lavage group and the endotracheal-aspiration group also had similar rates of targeted therapy (74.2% and 74.6%, respectively; P=0.90), days alive without antibiotics (10.4±7.5 and 10.6±7.9, P=0.86), and maximum organ-dysfunction scores (mean [±SD], 8.3±3.6 and 8.6±4.0; P=0.26). The two groups did not differ significantly in the length of stay in the ICU or hospital.

Conclusions Two diagnostic strategies for ventilator-associated pneumonia — bronchoalveolar lavage with quantitative culture of the bronchoalveolar-lavage fluid and endotracheal aspiration with nonquantitative culture of the aspirate — are associated with similar clinical outcomes and similar overall use of antibiotics. (Current Controlled Trials number, ISRCTN51767272 [controlled-trials.com] .)

Source Information

The Steering Committee (study chair, Daren Heyland, M.D., Kingston General Hospital and Queens University, Kingston, ON; Deborah Cook, M.D., St. Joseph's Hospital and McMaster University, Hamilton, ON; Peter Dodek, M.D., St. Paul's Hospital and University of British Columbia, Vancouver, BC; and John Muscedere, M.D., and Andrew Day, M.Sc., Kingston General Hospital and Queens University, Kingston, ON — all in Canada) of the Canadian Critical Care Trials Group assumes responsibility for the overall content and integrity of the article.

Address reprint requests to Dr. Heyland at Angada 4, Kingston General Hospital, Kingston, ON K7L 2V7, Canada, or at dkh2{at}post.queensu.ca.

Full Text of this Article

Related Letters:

Diagnosis of Ventilator-Associated Pneumonia
Chastre J., Fagon J.-Y., Misset B., Garrouste-Orgeas M., Carlet J., Marik P. E., Baram M., Heyland D., Cook D., Muscedere J., the Canadian Critical Care Trials Group
Extract | Full Text | PDF  
N Engl J Med 2007; 356:1469-1471, Apr 5, 2007. Correspondence

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