The Difficulty of Diagnosing Ventilator-Associated Pneumonia

The diagnosis of pneumonia in intubated, ventilated patients is difficult to confirm. This relates to the lack of specificity of physical examination findings, diagnostic imaging, cultures, and other laboratory tests. Organisms recovered from the upper airway or by suction through an endotracheal tube may be colonizers and not represent lower respiratory flora. Even bronchoscopic specimens may be contaminated by pharyngeal flora. Advances have been made in diagnosing adult ventilator-associated pneumonia (VAP) by quantitating the number of organisms recovered in bronchoalveolar lavage fluid. Organisms recovered in large numbers are the presumed etiologic agent.1,2 This problem is more challenging for diagnosing the intubated newborn because of the lack of specimens other …