"Blind" protected specimen brushing <I>versus</I> bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia

Abstract

The aetiological diagnosis of nosocomial pneumonia in intensive care unit (ICU) patients requires a valid, cheap and safe method. This method should be suitable for all mechanically-ventilated patients and all ICUs. The aim of this study was to assess the diagnostic yields of three methods: "blind" bronchial brushing (Accu-Cath)(protective specimen brush-nonbronchofibroscopic (PSB-non BF)); bronchofibroscopic protected specimen brushing (PSB-BF) and bronchoalveolar lavage (BAL).We prospectively studied the diagnostic values of the three methods as well as the agreement between microbiological results in 74 patients with 88 episodes of clinically suspected ventilator-associated pneumonia (VAP) and 22 control subjects. VAP episodes were also divided into those with (n=24) and without antibiotic pretreatment (n=64), and into those with (n=78) and without (n=10) right lower lobe infiltrates on chest radiography.No differences were found as regards the bacteriological yield of the three techniques. Furthermore, the rate of concordant results was high; 92% for PSB-BF and BAL; 84% for PSB-nonBF and BAL; 85% for PSB-nonBF and PSB-BF; and 85% for PSB-nonBF combined with both bronchoscopic techniques. The diagnostic yields in suspected VAP were 66, 59 and 56% for PSB-nonBF, PSB-BF and BAL, respectively.We conclude that "blind" bronchial brushing has similar accuracy to bronchoscopic techniques commonly used in the diagnosis of ventilator-associated pneumonia, constituting an interesting alternative in hospitals where fibreoptic bronchoscopy is not available.

Guidelines for the management of adult lower respiratory tract infections

“…Diagnostic accuracy is improved by the use of PSB, a technique introduced by WIMBERLEY et al [77], and BAL, at first using a bronchoscope but later not bronchoscopically taken (NB-BAL). The latter procedure is much more rapid and provides similar microbiological data in the diagnosis of ventilator-associated pneumonia [78,79].…”

Optimal Sampling Sites and Methods for Detection of Pathogens Possibly Causing Community-Acquired Lower Respiratory Tract Infections

“…Diagnostic accuracy is improved by the use of a protected specimen brush (PSB) (110) and BAL, at first performed through a bronchoscope and later not bronchoscopically taken (NB-BAL) (6,107). These procedures carry less risk and are usually more acceptable to patients than transtracheal aspiration and direct needle aspiration of the lung.…”

Evaluación de la concordancia entre dos métodos de lavado broncoalveolar para el diagnóstico microbiológico de la neumonía en pacientes con asistencia respiratoria mecánica

“…En la literatura revisada, al menos 12 estudios evaluaron, en 552 pacientes con sospecha de neumonía, el acuerdo diagnóstico, la concordancia microbiológica o ambas, existentes entre algunos métodos broncoscópicos y no broncoscópicos. En 10 de ellos se comparó el cepillado protegido, ciego, con el broncoscópico (8,(21)(22)(23)(24)(25)(26)(27)(28)(29), en cuatro, el cepillado protegido ciego con el lavado broncoalveolar broncoscópico (23)(24)(25)28), en dos, el lavado broncoalveolar no broncoscópico con el cepillado broncoscópico (22,30), y en sólo uno, el lavado broncoalveolar broncoscópico con el lavado broncoalveolar no broncoscópico (31).…”

“…Algunos autores también han comparado dos técnicas broncoscópicas entre sí, el cepillado protegido con el lavado broncoalveolar (23,25,26,28,(32)(33)(34), y dos pruebas ciegas, el cepillado protegido con el lavado broncoalveolar, ambos no broncoscópicos (35).…”

“…La mayoría sólo se limita a describir la disminución de la exactitud diagnóstica de las distintas técnicas usadas cuando los pacientes han recibido antibióticos recientemente (17,23,24,29,33,(35)(36)(37)(38). Sólo Bello y Timsit (23,32) evaluaron el acuerdo diagnóstico en estas circunstancias, ambos entre dos técnicas broncoscópicas, y encontraron resultados aparentemente contradictorios.…”