Santiago Ewig, MD; Michael Niederman, MD; Antoni Torres, MD
Ewig S., Niederman M., Torres A.; Management of Suspected Ventilator-Associated Pneumonia. Ann Intern Med. 2000;133:1008-1009. doi: 10.7326/0003-4819-133-12-200012190-00020
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Published: Ann Intern Med. 2000;133(12):1008-1009.
TO THE EDITOR:
Fagon and associates (1) conclude that the invasive management strategy for ventilator-associated pneumonia was significantly associated with reduced mortality at 14 days, earlier attenuation of organ dysfunction, and less antibiotic use. In our view, the study does not provide convincing evidence for any of the conclusions drawn.
The protocol basically includes a comparison of quantitative and qualitative cultures but not of invasive or noninvasive diagnostic strategies. Therefore, the conclusion that bronchoscopic diagnostic approaches are superior to any clinical approach is not justified. Moreover, the comparison remains doubtful (if not unfair) in that one well-standardized (invasive) strategy is tested against a clinical strategy that in fact does not reflect routine clinical practice. The very deliberate definition of clinical suspicion of ventilator-associated pneumonia establishes an intentional overtreatment in the control group.
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