Pulmonary Infections in Ventilated Patients: Diagnostic and Therapeutic Options.

The diagnosis of pulmonary infections in the ventilated patient has threatened the foundations of medicine. Although the lifesaving techniques of endotracheal intubation (developed for the treatment of diphtheria) and artificial ventilation (developed for the management of poliomyelitis) contribute greatly to medical care, they have resulted in the production of the "progress"-related infection of ventilator-associated pneumonia (VAP). Modern ventilator therapy is a substantial technologic advance from earlier days and, as technology inherently does, has removed some of the human element, the main foundation of Oslerian medical practice. The time-honored clinical diagnosis based on physical examination by an experienced physician has been seriously compromised in the approach to VAP.