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A national survey of the diagnosis and management of suspected ventilator-associated pneumonia

Lookup NU author(s): Dr Emma Browne, Dr Tom Hellyer, Dr Simon Baudouin, Professor John SimpsonORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© 2014, BMJ Publishing Group. All rights reserved. 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.

Publication metadata

Author(s): Browne E, Hellyer TP, Baudouin SV, Morris AC, Linnett V, McAuley DF, Perkins GD, Simpson AJ

Publication type: Article

Publication status: Published

Journal: BMJ Open Respiratory Research

Year: 2014

Volume: 1

Issue: 1

Print publication date: 01/12/2014

Online publication date: 19/12/2014

Acceptance date: 12/11/2014

Date deposited: 04/04/2017

ISSN (print): 2052-4439

Publisher: BMJ Publishing Group


DOI: 10.1136/bmjresp-2014-000066


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