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New infiltrates on chest X-ray, purulent secretions, and fever are hallmark signs of pneumonia, particularly in mechanically ventilated patients. In this context, the presence of new infiltrates on imaging suggests that there has been a process that leads to inflammation and infection in the lung parenchyma. This can be indicative of ventilator-associated pneumonia, a common complication in this patient population due to the disruption of normal airway defenses.

The production of purulent secretions reflects the body's immune response to the infective agents and often correlates with bacteria that can cause pneumonia. Fever is usually a sign of infection and is often observed in patients with pneumonia as the body attempts to fight off the pathogens.

While other signs, such as hypoxia and altered mental status, can occur in pneumonia cases, they are more generalized signs of respiratory distress or systemic illness rather than specific indicators of pneumonia itself. Additionally, patient anxiety and elevated blood pressure may accompany respiratory distress but do not specifically identify pneumonia. Decreased lung sounds and shallow breathing are nonspecific findings that can occur in various pulmonary conditions and are not exclusive to pneumonia. Therefore, the combination of new infiltrates, purulent secretions, and fever is the most accurate and specific indication of pneumonia in mechanically ventil