Diagnostic des pneumopathies acquises sous ventilation mécanique

Two strategies are available for the diagnosis and therapeutic management of ventilator-associated pneumonia (VAP). One based on clinical evaluation (also called noninvasive strategy) is safe, cheap and easy to use. However, this approach obviously leads to an excessive use of antibiotics due to the treatment of signs and symptoms suggesting lung infection, but frequently due to other infections or non-infectious inflammatory process. A microbiological strategy (or invasive) based on direct examination of protected brush or brochoalveolar lavage specimens obtained via a fiberoptic bronchoscopy permits to accurately select patients with VAP with a rapid identification of organisms responsible for infection. This strategy allowing the reduction of unnecessary antimicrobial regiments has been proven to be efficient.