Artificial Intelligence-Based Evaluation of Chest X-Rays in the Diagnosis of Ventilator-Associated Pneumonia in the Intensive Care Unit: A Retrospective Comparative Study

Inclusion Criteria

Inclusion Criteria: * Adult patients (≥18 years) * Admission to the anesthesia intensive care unit * Requirement of invasive mechanical ventilation for at least 48 hours * Clinical diagnosis of ventilator-associated pneumonia (VAP) based on institutional criteria * Availability of at least one chest X-ray prior to VAP diagnosis and one chest X-ray at the time of diagnosis * Availability of digital chest radiographs in the PACS system suitable for analysis Exclusion Criteria: * Age \<18 years * Absence of accessible digital chest radiographs * Chest radiographs with severe technical limitations preventing evaluation * Chest radiographs that could not be processed by the AI system (no score generated) * Presence of extensive pre-existing infiltrative lung disease preventing reliable assessment of new infiltrates * Missing key clinical data (e.g., VAP diagnosis date, mechanical ventilation duration)