To describe the current knowledge about clinical and microbiological diagnosis of nonventilated hospital-acquired pneumonia (NV-HAP).
NV-HAP is emerging as a new challenge for clinicians, particularly because VAP incidence has been decreasing. The clinical diagnosis of NV-HAP uses the classical clinical symptoms and signs. However standard evaluation of their accuracy and the evaluation of new criterion (e.g. lung ultrasound) must be conducted particularly in NV-HAP patients. The use of sputum must be encouraged in patients with NV-HAP, assuring its lower respiratory tract representativeness and quality. It is not clear that invasive approaches (e.g. BAL) are associated with improvements in patient-centred outcomes, and further research is needed to assure their correct indication, guaranteeing safety. Rapid diagnosis methods are promising in NV-HAP, particularly for the quick results and information about antibiotic resistance.
NV-HAP poses several barriers for diagnosis compared with VAP, and the available knowledge is limited. A call for further research in diagnosis of nonventilated HAP is urgent.
aPulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
bDepartment of Pulmonology, Hospital Clinic of Barcelona, University of Barcelona, Institut D’investigacions August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Barcelona, Spain
cDipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione – UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica – Istituto di Anestesia e Rianimazione. Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
dDisciplina de Emergências Clínicas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
Correspondence to Otavio T. Ranzani, MD, LIM/09 – Laboratório de Pneumologia, Disciplina de Pneumologia Faculdade de Medicina, Universidade de São Paulo, Av. Dr Arnaldo, 455, 2° andar, sala 2144, CEP 01246903, São Paulo, Brazil. Tel: +55 11 3061 7361; e-mail: firstname.lastname@example.org