The Rational Clinical Examination
David L. Simel, Drummond Rennie
Pneumonia, Ventilator-Associated
Michael Klompas
Sections:
Clinical Scenario, Why Is This an Important Clinical Issue?, Methods, Results, Scenario Resolution, The Bottom Line, References
Topics Discussed:
mechanical ventilation, pneumonia, ventilator-associated pneumonia
Excerpt:
"A 68-year-old man with a history of congestive heart failure
and remote non–small cell lung cancer suddenly develops
shortness of breath. His initial chest radiograph shows diffuse
infiltrates consistent with pulmonary edema. On arrival at the hospital,
respiratory distress and hypoxemia necessitate intubation and ventilatory
support. The patient is transferred to the intensive care unit and
given diuretics, sedatives, and ulcer prophylaxis administered through
a central venous catheter. Anticoagulants are started when a pulmonary
embolus is confirmed. Over the ensuing 4 days he slowly improves,
the radiographic infiltrates diminish, and his level of ventilatory
support is gradually decreased...."
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