Abstract
The optimal strategy for ventilator-associated pneumonia remains controversial. To clarify the tradeoffs involved, we performed a decision analysis. Strategies evaluated included antibiotic therapy with and without diagnostic testing. Tests that were explored included endotracheal aspirates, bronchoscopy with protected brush or bronchoalveolar lavage, and nonbronchoscopic mini-bronchoalveolar lavage (mini-BAL). Outcomes included dollar cost, antibiotic use, survival, cost-effectiveness, antibiotic use per survivor, and the outcome perspective of financial cost-antibiotic use per survivor. Initial coverage with three antibiotics was better than expectant management or one or two antibiotic approaches, leading to both improved survival (54% vs. 66%) and decreased cost ($55,447 vs. $41,483 per survivor). Testing with mini-BAL did not improve survival but did decrease costs ($41,483 vs. $39,967) and antibiotic use (63 vs. 39 antibiotic days per survivor). From the perspective of minimizing cost, minimizing antibiotic use, and maximizing survival, the best strategy was three antibiotics with mini-BAL.
Original language | English (US) |
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Pages (from-to) | 1060-1067 |
Number of pages | 8 |
Journal | American journal of respiratory and critical care medicine |
Volume | 168 |
Issue number | 9 |
DOIs | |
State | Published - Nov 1 2003 |
Externally published | Yes |
Keywords
- Bronchoscopy
- Decision analysis
- Evidence-based medicine
- Ventilator-associated pneumonia
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine