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[Diagnosis of pneumonia in long-term ventilated patients. Value of digital luminescence radiography in comparison with clinical and microbiological monitoring].

PURPOSE
Pulmonary infection is one of the most feared complications in patients receiving long-term ventilation. We evaluated prospectively the diagnostic value of daily bedside chest radiography performed as digital luminescence radiography (DLR) in comparison to clinical findings and quantitative microbial culture.


MATERIAL AND METHODS
Prospective evaluation of daily bedside chest radiography (DLR) and clinical parameters such as blood count, body temperature, and microbiological monitoring (quantitative culturing, microscopy) of 20 patients receiving long-term ventilation was undertaken. Altogether 325 chest radiographs were evaluated.


RESULTS
96% of the routine radiographs showed abnormal findings. Nosocomial pneumonia was suspected in 31% of all 330 days of observation by means of clinical and microbiological findings. DLR showed correct findings in 80% of this days (right-positive interpretation); a false-positive interpretation was resulted in 16 radiographs. Most common finding in nosocomial pneumonia was an alveolar pattern with air bronchogram. Fever and leucocytosis often precede radiological evidence of pneumonia.


CONCLUSION
Daily bedside chest radiography performed as DLR shows abnormal finding in a high percentage. Bedside chest radiograph is in accordance to clinical and microbiological finding of nosocomial pneumonia in 80%.