Study designs of evaluations included in the review
Randomised controlled trials (RCTs) and prospective observational studies were eligible for inclusion.
Specific interventions included in the review
Studies of invasive testing for the diagnosis of VAP were eligible for inclusion. The specific interventions evaluated by the included studies were protected specimen brush, with or without bronchoalveolar lavage, or mini-bronchoalveolar lavage.
Reference standard test against which the new test was compared
The review did not include any diagnostic accuracy studies that compared the performance of the index test with a reference standard of diagnosis.
Participants included in the review
Studies that evaluated patients for possible VAP were eligible for inclusion. Studies that included patients who underwent testing for the diagnosis of severe community-acquired pneumonia requiring mechanical ventilation were excluded. VAP was confirmed bronchoscopically in 44 to 69% of patients, Acute Physiology and Chronic Health Evaluation (APACHE) scores ranged from 15 to 46, and the duration of mechanical ventilation prior to enrolment ranged from 6 to 11 days.
Outcomes assessed in the review
Studies had to report data on the impact of testing on mortality in patients with VAP and on antibiotic prescribing to be included in the review. Mortality was the primary outcome; antibiotic management was the secondary outcome.
How were decisions on the relevance of primary studies made?
Two reviewers independently screened studies for inclusion in the review.