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Nosocomial pneumonia.

M T Hessen1, D Kaye

  • 1Department of Medicine, Medical College of Pennsylvania, Philadelphia.

Critical Care Clinics
|April 1, 1988
PubMed
Summary
This summary is machine-generated.

Diagnosing and treating nosocomial pneumonia in critically ill patients is difficult due to confounding factors. Invasive diagnostic methods like sheathed bronchoscopy and open lung biopsy are crucial when standard tests fail.

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Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pulmonology

Background:

  • Nosocomial pneumonia presents diagnostic and therapeutic challenges in critically ill patients.
  • Confounding factors like heart failure, ARDS, and prior antibiotic use complicate diagnosis.
  • Colonizing organisms can further hinder accurate pneumonia identification.

Purpose of the Study:

  • To review the diagnostic and therapeutic strategies for nosocomial pneumonia in critically ill patients.
  • To highlight the difficulties in diagnosing nosocomial pneumonia.
  • To discuss the role of invasive diagnostic procedures.

Main Methods:

  • Review of diagnostic challenges and therapeutic approaches for nosocomial pneumonia.
  • Discussion of confounding factors influencing diagnosis.

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  • Evaluation of invasive diagnostic techniques, including sheathed fiberoptic bronchoscopy and open lung biopsy.

    • Main Results:

    • Nosocomial pneumonia diagnosis is often obscured by other conditions and prior treatments.
    • Sheathed fiberoptic bronchoscopy with quantitative culture and biopsy is a valuable initial invasive test.
    • Open lung biopsy is considered the gold standard for diagnosis.

    Conclusions:

    • Accurate diagnosis of nosocomial pneumonia requires careful consideration of clinical context and potential confounders.
    • Invasive diagnostic methods are essential when routine approaches are insufficient.
    • Empiric antimicrobial therapy should be guided by suspected pathogens based on laboratory results or clinical presentation.