title: A national survey of the diagnosis and management of suspected ventilator-associated pneumonia.
abstract: 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.
authors.affiliation: Institute of Cellular Medicine, Newcastle University , Newcastle upon Tyne , UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Browne
authors.affiliation: Institute of Cellular Medicine, Newcastle University , Newcastle upon Tyne , UK.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Hellyer
authors.affiliation: Institute of Cellular Medicine, Newcastle University , Newcastle upon Tyne , UK.
authors.forename: Simon V
authors.initials: SV
authors.lastname: Baudouin
authors.affiliation: MRC Centre for Inflammation Research, University of Edinburgh, and Critical Care NHS Lothian , Edinburgh , UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Conway Morris
authors.affiliation: Queen Elizabeth Hospital, Gateshead Health NHS Trust , Gateshead , UK.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Linnett
authors.affiliation: Centre for Infection and Immunity, Queen's University Belfast and Regional Intensive Care Unit, Royal Victoria Hospital Belfast , Belfast , Northern Ireland.
authors.forename: Danny F
authors.initials: DF
authors.lastname: McAuley
authors.affiliation: Warwick Medical School and Heart of England NHS Foundation Trust , Birmingham , UK.
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Perkins
authors.affiliation: Institute of Cellular Medicine, Newcastle University , Newcastle upon Tyne , UK.
authors.forename: A John
authors.initials: AJ
authors.lastname: Simpson
keywords: Assisted Ventilation; Pneumonia; Respiratory Infection