Pneumonia · Diagnosing ventilator-associated pneumonia
A randomized trial of diagnostic techniques for ventilator-associated pneumonia
| Design | Multicentre randomised controlled trial in 28 intensive care units |
|---|---|
| Treatment | Bronchoalveolar lavage with quantitative culture |
| Control | Endotracheal aspiration with non-quantitative culture |
| Population | 740 patients with suspected ventilator-associated pneumonia in Canada and the United States |
| Follow-up | 28 days |
| Primary endpoint | 28-day mortality |
| Result | 28-day mortality was 18.9% in the bronchoalveolar-lavage group and 18.4% in the endotracheal-aspiration group (p=0.94), with similar rates of targeted therapy and antibiotic use between the strategies. |
| Secondary endpoints | Targeted antibiotic therapy, days alive without antibiotics, organ dysfunction |
Two diagnostic strategies for ventilator-associated pneumonia — bronchoalveolar lavage with quantitative culture of the bronchoalveolar-lavage fluid and endotracheal aspiration with nonquantitative culture of the aspirate — are associated with similar clinical outcomes and similar overall antibiotic use.
The trial authors, in the published abstract
Ends a long methodological argument in favour of the simpler test. The invasive strategy was defended on the grounds that it would reduce antibiotic exposure; it did not. Antibiotic duration, which PneumA addressed, turned out to be the lever that matters.
A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 2006 Dec 21;355(25):2619-30.