The Rational Clinical Examination
David L. Simel, Drummond Rennie
Pneumonia, Ventilator-Associated
David L. Simel
Make the Diagnosis: Pneumonia, Ventilator-Associated
Topics Discussed:
criterion standard comparisons (diagnostic tests), diagnosis, diagnosis, differential, diagnostic process, likelihood ratio, make the diagnosis, mechanical ventilation, pneumonia, prior probability, reference standards, ventilator-associated pneumonia
Excerpt:
"Ventilated patients are highly susceptible to pneumonia with
pooled cumulative incidence of 9.7% of ventilated patients
in a meta-analysis of 38 units published in 2005.1 This
incidence was 9.1% in combined medical-surgical units and
17% in medical.1 In 2008, the US Joint
Commission launched a multiyear effort to decrease the incidence
of ventilator-associated pneumonia.2 This may translate
to lower rates in individual units and clinicians are encouraged
to be aware of their local improvement efforts to have an understanding
of the incidence in their intensive care unit. In addition, the
probability of ventilator-assisted pneumonia likely increases with
days of ventilator support, so individual patient risk should be
modified for length of intubation...."
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