Amikacin for Ventilator-Associated Pneumonia (AMIKINHAL trial)
You don’t hear much about ventilator-associated pneumonia (VAP) anymore. It used to be highly prevalent in U.S. ICUs, and a popular research focus for academics, generating a steady stream of papers. Then, in 2009, the condition disappeared completely.
Just kidding! In 2008, the U.S. government proposed adding VAP to its “hospital-acquired conditions” list—the ones that it won’t pay for. Hospital administrators put VAP on the kill list. Its incidence was closely tracked, and nonprofit organizations provided bundles for how to eradicate it. And maybe, noticing all the fuss, some clinicians might have started coding for VAP slightly less often in equivocal cases.
The diagnostic ambiguity is real: the diagnosis of VAP depends on contamination-prone sputum cultures and subjective interpretations of portable chest films in intubated patients (who are usually obese, with some degree of volume overload, often making it hard to say whether a new infiltrate is present). This made VAP hard to tr…
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