The Invasive Diagnostic Strategy - Flowchart
The Invasive Diagnostic Strategy - Flowchart Pneumonia, Bacterial Pneumonia, Bacterial
«Flowchart»

Clinical features suggesting VAP?

Clinical features suggesting VAP?

Clinical features suggesting VAP?

YES

YES

YES

Immediate sampling of distal airways by bronchoscopy with BAL/PSB before introduction of new antibiotics

Immediate sampling of distal airways by bronchoscopy with BAL/PSB before introduction of new antibiotics

Immediate sampling of distal airways by bronchoscopy with BAL/PSB before introduction of new antibiotics

Direct specimen examination

Direct specimen examination

Direct specimen examination

Start antibiotics immediately using direct specimen examination results and local epidemiology

Start antibiotics immediately using direct specimen examination results and local epidemiology

Start antibiotics immediately using direct specimen examination results and local epidemiology

Bacteria present

Bacteria present

Bacteria present

YES

YES

YES

NO

NO

NO

End

End

End

Observe: Look for another infection(s)

Observe: Look for another infection(s)

Observe: Look for another infection(s)

Start antibiotics immediately using ATS/IDSA guidelines

Start antibiotics immediately using ATS/IDSA guidelines

Start antibiotics immediately using ATS/IDSA guidelines

Signs of severe sepsis

Signs of severe sepsis

Signs of severe sepsis

YES

YES

YES

NO

NO

NO

Select antibiotics based on culture results

Select antibiotics based on culture results

Select antibiotics based on culture results

Observe, look for other infection(s)

Observe, look for other infection(s)

Observe, look for other infection(s)

Positive quantitative cultures

Positive quantitative cultures

Positive quantitative cultures

YES

YES

YES

NO

NO

NO