Article Text

A national survey of the diagnosis and management of suspected ventilator-associated pneumonia
  1. Emma Browne1,
  2. Thomas P Hellyer1,
  3. Simon V Baudouin1,
  4. Andrew Conway Morris2,
  5. Vanessa Linnett3,
  6. Danny F McAuley4,
  7. Gavin D Perkins5 and
  8. A John Simpson1
  1. 1Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
  2. 2MRC Centre for Inflammation Research, University of Edinburgh, and Critical Care NHS Lothian, Edinburgh, UK
  3. 3Queen Elizabeth Hospital, Gateshead Health NHS Trust, Gateshead, UK
  4. 4Centre for Infection and Immunity, Queen's University Belfast and Regional Intensive Care Unit, Royal Victoria Hospital Belfast, Belfast, Northern Ireland
  5. 5Warwick Medical School and Heart of England NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Emma Browne; emurielbrowne{at}yahoo.co.uk

Abstract

Background Ventilator-associated pneumonia (VAP) affects up to 20% of patients admitted to intensive care units (ICU). It is associated with increased morbidity, mortality and healthcare costs. Despite published guidelines, variability in diagnosis and management exists, the extent of which remains unclear. We sought to characterise consultant opinions surrounding diagnostic and management practice for VAP in the UK.

Methods An online survey was sent to all consultant members of the UK Intensive Care Society (n=∼1500). Data were collected regarding respondents’ individual practice in the investigation and management of suspected VAP including use of diagnostic criteria, microbiological sampling, chest X-ray (CXR), bronchoscopy and antibiotic treatments.

Results 339 (23%) responses were received from a broadly representative spectrum of ICU consultants. All respondents indicated that microbiological confirmation should be sought, the majority (57.8%) stating they would take an endotracheal aspirate prior to starting empirical antibiotics. Microbiology reporting services were described as qualitative only by 29.7%. Only 17% of respondents had access to routine reporting of CXRs by a radiologist. Little consensus exists regarding technique for bronchoalveolar lavage (BAL) with the reported volume of saline used ranging from 5 to 500 mL. 24.5% of consultants felt inadequately trained in bronchoscopy.

Conclusions There is wide variability in the approach to diagnosis and management of VAP among UK consultants. Such variability challenges the reliability of the diagnosis of VAP and its reported incidence as a performance indicator in healthcare systems. The data presented suggest increased radiological and microbiological support, and standardisation of BAL technique, might improve this situation.

  • Respiratory Infection
  • Pneumonia
  • Assisted Ventilation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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