Chest
Evaluation of Clinical Judgment in the Identification and Treatment of Nosocomial Pneumonia in Ventilated Patients
Section snippets
Study Population
Patients meeting the following criteria were eligible for the study: (1) the patient had been receiving mechanical ventilation for more than 72 h in the medical intensive care unit of Hopital Bichat, Paris, France; (2) had a new and persistent (>24 h) infiltrate on chest roentgenograms; (3) had macroscopically purulent tracheal aspirates; and (4) had a clinical status permitting the performance of flexible fiberoptic bronchoscopy. No patients were included in the study if changes in antibiotic
RESULTS
Clinical Outcome of Patients Suspected of Having Nosocomial Pneumonia
Among the 84 patients suspected of having nosocomial pneumonia, the diagnosis of bacterial pneumonia was ultimately made in only 27 patients (definite, n = 17; probable, n = 10) and excluded in 57 patients (definite no pneumonia, n = 34; probable no pneumonia, n= 23).
The clinical characteristics of patients who had pneumonia and of those who did not were very similar (Table 1). No significant differences in clinical
DISCUSSION
In this study, we have evaluated the reliability of clinical judgment in identifying nosocomial pneumonia in patients receiving mechanical ventilation and in selecting appropriate antimicrobial therapy. We observed that clinical assessment alone often resulted in substandard management of patients with pneumonia, either because pneumonia was not correctly diagnosed or because the antibiotics selected were inappropriate. Overall, only 33 percent of the predictions made in patients with pneumonia
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Supported in part by a grant from the Faculté Xavier Bichat.
Presented in part at the Annual Meeting, American Thoracic Society, Las Vegas, April 1988.
Manuscript received March 6; revision accepted June 16.