Table 2 A summary table of the advantages and disadvantages of clinical, radiological and microbiological assessment tools for the diagnosis of VAP
From: Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges
| Â | Advantages | Disadvantages |
|---|---|---|
Bedside Clinical Symptoms | •Inexpensive •Rapid, bedside assessment •Any clinician/grade •Foundation of clinical suspicion | •Nonspecific to the cause of infection •Overlap with many disease processes •Confounded by ICU imposed factors •Inconclusive |
Radiological Diagnosis | CT | |
•3D imaging •High resolution of different densities •Accurate | •Radiation risk •Transfer risks •Time delay •Cost | |
CXR | ||
•Portable enabling a bedside assessment •Rapid •Pragmatic •Inexpensive | •2D imaging only •Patient positioning limited •Difficult interpretation •Overlap with many disease processes •Benefits from comparison images | |
Lung Ultrasound | ||
•Portable enabling a bedside assessment •Rapid •Inexpensive •Minimal radiation •Dynamic exploration | •Specialist training •Limitations include body habitus and subcutaneous emphysema •Not a recognised or validated assessment tool | |
Microbiological Diagnosis | Non-invasive techniques | |
•Simple •Safe •Rapid/efficient to obtain a sample •Obtained by a breadth of ICU staff groups •Does not require extensive training | •Cross-contamination risk •Unable to isolate lower respiratory tract | |
Invasive techniques | ||
•Targets the lower respiratory tract, therefore, more specific | •Not routinely available over 24 h •Requires specialist training •Risk of patient instability | |
Qualitative techniques | ||
•Simple •Quicker and more efficient than quantitative methods | •Not specific to the exact organism | |
Quantitative techniques | ||
•Specific •Allows for targeted antibiotic therapy | •Timely •Costly •Laboratory resources •Expertise required | |
