Invasive oder nicht-invasive Diagnostik der Ventilator-assoziierten Pneumonie: Ergebnisse der Canadian Critical Care Trials Group
Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection on intensive care units (ICU). VAP has consequences on mortality, duration of stay on the ICU and in the hospital and increases costs of treatment. Clinical studies indicated that an early and calculated treatment with broad-spectrum antibiotics is highly important for the success of treatment on the ICU. To minimize formation of resistance, early deescalation or termination of this chosen therapy is necessary and may be based on clinical criteria and especially microbiological examination. The latter case needs extraction of secretions in the upper respiratory tract. Invasive techniques (bronchoalveolar lavage, BAL) and non-invasive techniques (endotracheal aspiration, ETA) can be used. There is no agreement between studies about which method leads most frequently to correct results and results in improving outcome of patients. The study performed by the Canadian critical care trials group (December 21, 2006, NEJM) examined 740 patients on intensive care units. Patients were randomized both depending on the diagnostic method (ETA vs BAL) and the antibiotic treatment (mono- vs combined antibiotic therapy). The 28-day mortality was chosen as the primary outcome parameter, while duration of mechanical ventilation and duration of stay on the ICU were chosen among other things as secondary parameters. The results indicated no significant differences between the groups for these parameters. Patients undergoing BAL were treated significantly later by study antibiotics. This difference had no effect on patients' outcome. The special selection of the study population, which excluded pre-colonized and chronically ill patients, reduces the possibility to rate these results. Furthermore, based on the results of this study, recommendation for one of the used techniques in diagnosing VAP can not be given.
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