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Diagnosis of nonventilated hospital-acquired pneumonia

how much do we know?

Ranzani, Otavio T.a,b; De Pascale, Gennaroc; Park, Marcelod

Current Opinion in Critical Care: October 2018 - Volume 24 - Issue 5 - p 339–346
doi: 10.1097/MCC.0000000000000525
INFECTIOUS DISEASES: Edited by Antoni Torres

Purpose of review To describe the current knowledge about clinical and microbiological diagnosis of nonventilated hospital-acquired pneumonia (NV-HAP).

Recent findings 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.

Summary 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: otavioranzani@yahoo.com.br

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