Evidence map›Paper›PMID 32306086›Full record

SynthesisIntensive care medicine2020

Diagnosis of ventilator-associated pneumonia in critically ill adult patients-a systematic review and meta-analysis.

Shannon M Fernando, Alexandre Tran, Wei Cheng, Michael Klompas, Kwadwo Kyeremanteng, Sangeeta Mehta, Shane W English, John Muscedere, Deborah J Cook, Antoni Torres and 6 more

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Intensive care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 101 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
101citing papers in PubMed, 7 pooled it
12.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

101 citing papers in PubMed, 7 syntheses or guidelines pooled it, 222 citations in OpenAlex.

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  15. Challenges and opportunities in the management of severe pneumonia. Key concepts from the Seventh Annual Meeting of Spanish Experts 2025.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026
    Review
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41 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors at 9 institutions in 4 countries.

Shannon M FernandoDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca.
Alexandre TranDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Wei ChengClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Michael KlompasDepartment of Population Medicine, Harvard Medical School, Boston, MA, USA.
Kwadwo KyeremantengDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Sangeeta MehtaInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Shane W EnglishDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
John MuscedereDepartment of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
Deborah J CookDepartment of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Antoni TorresDepartment of Pulmonary and Critical Care Medicine, Hospital Clinic Barcelona, Barcelona, Spain.
Otavio T RanzaniPulmonary Division, Heart Institute, Universidade de Sao Paulo, São Paulo, Brazil.
Alison E Fox-RobichaudDepartment of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Waleed AlhazzaniDepartment of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Laveena MunshiInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Gordon H GuyattDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Bram RochwergDepartment of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Impact · CAUniversity of Ottawa · CAUniversity of Toronto · CABrigham and Women's Hospital · USHospital Clínic de Barcelona · ESMcMaster University · CAOttawa Hospital · CAQueen's University · CAUniversidade de São Paulo · BR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The accuracy of the signs and tests that clinicians use to diagnose ventilator-associated pneumonia (VAP) and initiate antibiotic treatment has not been well characterized. We sought to characterize and compare the accuracy of physical examination, chest radiography, endotracheal aspirate (ETA), bronchoscopic sampling cultures (protected specimen brush [PSB] and bronchoalveolar lavage [BAL]), and CPIS > 6 to diagnose VAP. We searched six databases from inception through September 2019 and selected English-language studies investigating accuracy of any of the above tests for VAP diagnosis. Reference standard was histopathological analysis. Two reviewers independently extracted data and assessed study quality. We included 25 studies (1639 patients). The pooled sensitivity and specificity of physical examination findings for VAP were poor: fever (66.4% [95% confidence interval [CI]: 40.7-85.0], 53.9% [95% CI 34.5-72.2]) and purulent secretions (77.0% [95% CI 64.7-85.9], 39.0% [95% CI 25.8-54.0]). Any infiltrate on chest radiography had a sensitivity of 88.9% (95% CI 73.9-95.8) and specificity of 26.1% (95% CI 15.1-41.4). ETA had a sensitivity of 75.7% (95% CI 51.5-90.1) and specificity of 67.9% (95% CI 40.5-86.8). Among bronchoscopic sampling methods, PSB had a sensitivity of 61.4% [95% CI 43.7-76.5] and specificity of 76.5% [95% CI 64.2-85.6]; while BAL had a sensitivity of 71.1% [95% CI 49.9-85.9] and specificity of 79.6% [95% CI 66.2-85.9]. CPIS > 6 had a sensitivity of 73.8% (95% CI 50.6-88.5) and specificity of 66.4% (95% CI 43.9-83.3). Classic clinical indicators had poor accuracy for diagnosis of VAP. Reliance upon these indicators in isolation may result in misdiagnosis and potentially unnecessary antimicrobial use.

Indexed as

Pneumonia, Ventilator-AssociatedAdultBronchoalveolar LavageBronchoalveolar Lavage FluidCritical IllnessHumansRespiration, ArtificialSensitivity and SpecificityCritical careMechanical ventilationNosocomial infectionsVentilator-associated pneumonia

Identifiers

PMID32306086
PMCPMC7223448
OpenAlexW3016513391

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.