不符合洗脑诊断标准的疑似呼吸机相关肺炎患者的替代诊断。

Rik J Schoemakers, Ronny Schnabel, Guy J Oudhuis, Catharina F M Linssen, Walther N K A van Mook, Annelies Verbon, Dennis C J J Bergmans
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引用次数: 6

摘要

背景:呼吸机相关性肺炎(VAP)的临床表现可被其他传染性和非传染性疾病所模仿。本研究的目的是确定替代诊断,并制定一个诊断流程图的患者怀疑有VAP不符合诊断支气管肺泡灌洗(BAL)标准。方法:纳入临床怀疑有VAP且BAL结果阴性的成人重症监护患者。临床对VAP的怀疑是基于临床、放射学和微生物学标准的结合。如果细胞分化显示≥2%的细胞有胞内生物和/或定量培养结果≥10(4)cfu/ml,则认为BAL阳性。最可能的发热和肺密度的替代诊断是由两位作者独立地回顾性确定的。结果:207例疑似VAP患者中,110例不符合BAL诊断标准,需要进一步诊断评价。在67例患者中可以找到发热的替代诊断。在51例患者中,可以确定发热和肺密度的替代诊断。几乎40%的患者无法提供其他诊断。10例患者诊断为非细菌性肺炎,以单纯疱疹病毒1型(HSV-1)为最常见的病原体。8例患者被诊断为非传染性肺炎。结论:由于替代诊断和应用测试的范围广泛,诊断工作必须个体化,并以反复临床评估为指导。最常见的替代诊断是病毒性肺炎和非传染性肺炎。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Alternative diagnosis in the putative ventilator-associated pneumonia patient not meeting lavage-based diagnostic criteria.

Background: The clinical picture of ventilator-associated pneumonia (VAP) can be mimicked by other infectious and non-infectious diseases. The aim of this study was to determine the alternative diagnoses and to develop a diagnostic flow chart for patients suspected of having VAP not meeting the diagnostic broncho-alveolar lavage (BAL) criteria.

Methods: Adult intensive care patients with a clinical suspicion of VAP and negative BAL results were included. The clinical suspicion of VAP was based on the combination of clinical, radiological, and microbiological criteria. BAL was considered positive if cell differentiation revealed ≥ 2% cells with intracellular organisms and/or quantitative culture results of ≥ 10(4) cfu/ml. The most likely alternative diagnosis of fever and pulmonary densities was retrospectively determined by two authors independently.

Results: In all, 110 of 207 patients with suspected VAP did not meet the diagnostic BAL criteria and required further diagnostic evaluation. In 67 patients an alternative diagnosis for fever could be found. In 51 patients an alternative diagnosis of both fever and pulmonary densities could be established. In almost 40% of patients no alternative diagnosis could be provided. Non-bacterial pneumonia was diagnosed in 10 patients with Herpes simplex virus 1 (HSV-1) as the most common pathogen. In eight patients non-infectious pneumonitis was diagnosed.

Conclusion: Due to the wide range of alternative diagnoses and applied tests the diagnostic work-up proved to be necessarily individualized and guided by repeated clinical assessment. The most frequently found alternative diagnoses were viral pneumonia and non-infectious pneumonitis.

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