Clinical diaqnosis of pneumonia

The clinical diagnosis of pneumonia in ventilated patients is difficult. The usual criteria include the following:

1. new or progressive chest radiograph infiltrates;

3. leukocytosis or leukopenia;

4. new or increasing purulent tracheobronchial secretions.

Using six variables may increase the prognostic power (Niederman. etal; 1994). Mechanically ventilated patients are rapidly colonized with Gram-negative organisms, making interpretation of tracheobronchial cultures difficult. Non-infectious causes of chest radiograph infiltrates are common and there are many causes of fever other than pneumonia (Meduri 1990). Thus clinical criteria alone are insufficient to diagnose ventilator-associated pneumonia, with as few as one-third of clinical diagnoses being confirmed.

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