An intubated, mechanically ventilated patient is suspected of developing nosocomial pneumonia. The pulmonologist decides to perform a bronchoscopy. Which bronchoscopy findings would be consistent with pneumonia?

1. Alveolar collapse
2. Distal purulent secretions
3. Persistent secretions surging from distal bronchi during exhalation
4. P/F ratio less than 50
a. 2, 3, and 4 only
b. 1 and 3 only
c. 2 only
d. 3 and 4 only

ANS: A
Direct visualization by bronchoscopy of the lower airway in ventilated patients is sometimes helpful in supporting the diagnosis of VAP. In one recent study, the presence of distal, purulent secretions; persistence of secretions surging from distal bronchi during exhalation; and a decrease in the PaO2/FiO2 ratio of less than 50 were independently associated with the presence of pneu-monia.