In Reply: We agree with Dr Klompas about the lack of an optimal definition for VAP. This controversy was the rationale for choosing clinical and radiographic parameters combined with culture-positive fluid obtained by BAL to define VAP in the NASCENT study. Specifically, new radiographic infiltrate plus qualifying clinical signs served as triggers for performing quantitative BAL. This diagnostic approach is consistent with guidelines from the American Thoracic Society1 and Chastre and Fagon.2 Furthermore, this definition was clinically meaningful as demonstrated by the association between microbiologically confirmed VAP and increased durations of intubation, stay in the ICU, and hospital stay in our post hoc multivariate analysis.
Kollef MH, Afessa B, Anzueto A. Silver-Coated Endotracheal Tubes and Patient Outcomes in Ventilator-Associated Pneumonia—Reply. JAMA. 2008;300(22):2605-2606. doi:10.1001/jama.2008.761