Ventilator-associated pneumonia (VAP) is a prevalent and grave hospital-acquired infection that affects mechanically ventilated patients. Diverse diagnostic criteria can significantly affect VAP research by complicating the identification and management of the condition, which may also impact clinical management. We conducted this review to assess the diagnostic criteria and the definitions of the term “ventilator-associated” used in randomised controlled trials (RCTs) of VAP management. Based on the protocol (PROSPERO 2019 CRD42019147411), we conducted a systematic search on MEDLINE/PubMed and Cochrane CENTRAL for RCTs, published or registered between 2010 and 2024. We included completed and ongoing RCTs that assessed pharmacological or non-pharmacological interventions in adults with VAP. Data were collected using a tested extraction sheet, as endorsed by the Cochrane Collaboration. After cross-checking, data were summarised in a narrative and tabular form. In total, 7,173 records were identified through the literature search. Following the exclusion of records that did not meet the eligibility criteria, 119 studies were included. Diagnostic criteria were provided in 51.2% of studies, and the term “ventilator-associated” was defined in 52.1% of studies. The most frequently included diagnostic criteria were pulmonary infiltrates (96.7%), fever (86.9%), hypothermia (49.1%), sputum (70.5%), and hypoxia (32.8%). The different criteria were used in 38 combinations across studies. The term “ventilator-associated” was defined in nine different ways. When provided, diagnostic criteria and definitions of VAP in RCTs display notable variability. Continuous efforts to harmonise VAP diagnostic criteria in future clinical trials are crucial to improve quality of care, enable accurate epidemiological assessments, and guide effective antimicrobial stewardship.

中文翻译：

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揭示呼吸机相关肺炎的复杂性：对临床研究中使用的诊断标准和定义进行系统方法学文献综述


呼吸机相关性肺炎（VAP）是一种流行且严重的医院获得性感染，影响机械通气患者。不同的诊断标准会使病情的识别和管理变得复杂，从而显着影响 VAP 研究，这也可能影响临床管理。我们进行此次综述的目的是评估 VAP 管理随机对照试验 (RCT) 中使用的诊断标准和术语“呼吸机相关”的定义。根据方案 (PROSPERO 2019 CRD42019147411)，我们对 MEDLINE/PubMed 和 Cochrane CENTRAL 进行了系统性检索，以查找 2010 年至 2024 年间发表或注册的随机对照试验。我们纳入了已完成和正在进行的随机对照试验，这些随机对照试验评估了成人患有以下疾病的药物或非药物干预措施： VAP。数据是使用经 Cochrane 协作组织认可的经过测试的提取表收集的。经过交叉检查后，数据以叙述和表格的形式进行总结。通过文献检索，共查出 7,173 条记录。排除不符合资格标准的记录后，纳入了 119 项研究。 51.2% 的研究提供了诊断标准，52.1% 的研究定义了术语“呼吸机相关”。最常见的诊断标准是肺部浸润（96.7%）、发热（86.9%）、体温过低（49.1%）、痰（70.5%）和缺氧（32.8%）。研究中的 38 种组合使用了不同的标准。 “呼吸机相关”一词有九种不同的定义。当提供时，随机对照试验中 VAP 的诊断标准和定义显示出显着的变异性。 在未来的临床试验中不断努力协调 VAP 诊断标准对于提高护理质量、实现准确的流行病学评估和指导有效的抗菌药物管理至关重要。