“Blind” Protected Specimen Brushing vs Bronchoscopic Techniques in the Aetiological Diagnosis of Ventilator-associated Pneumonia

Bello, Salvador; Tejada, A Lerdo de; Chacón, Enrique; Villuendas, María Cruz; Senar, Alba Castán; Gascón, Maria Rita Polo; Suárez, Francisco Javier Ozores

doi:10.1016/s0012-3692(15)53058-4

Cited by 6 publications

(8 citation statements)

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“…Furthermore, by using the same patient, and randomizing which technique to use first, as well as blinding the laboratory technician reading the cultures, we minimized bias. Our study also suggested that VAP is a diffuse disease involving multiple lobes, and samples obtained blindly have a comparable performance to FOB-guided samples 11,20,21,[27][28][29][30] . Furthermore, histology-based reports suggest VAP is predominantly a dependent lung segment disease 24 where is more likely that a nasogastric tube will go.…”

Section: Discussionmentioning

confidence: 61%

Comparison of Bronchoscopic Bronchoalveolar Lavage vs Blind Lavage With a Modified Nasogastric Tube in the Etiologic Diagnosis of Ventilator-Associated Pneumonia

Leos

Galindo-Galindo

Folch

et al. 2007

Chest

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Objective. Our objective was to compare the results of a blind lavage vs a bronchoscopic-guided bronchoalveolar lavage for the etiologic diagnosis of ventilator-associated pneumonia (VAP).Design. Prospective study in consecutive patients with high probability of VAP. Every patient underwent both procedures, in a formally randomized fashion. The interpretation of quantitative cultures was done in a blind fashion.Setting. Single center study, with a 20 bed medical and surgical Intensive Care Unit of the University Hospital in Monterrey, Mexico.Patients. Twenty-five patients with high probability of VAP.Interventions. Every patient underwent blind bronchoalveolar lavage with a modified nasogastric tube, and a bronchospic-guided bronchoalveolar lavage.Results. Twenty-one patients underwent both procedures. Four patients were excluded due to contamination of the cultures. The quantitative cultures were compared in a paired fashion. Only two patients had discordant cultures. The correlation coefficient between the number of colonies was very high, r = 0.90 (95% confidence interval [CI], 0.77-0.96; p = 0.0001). Conclusiones. El lavado broncoalveolar ciego con sonda nasogástrica modificada es una herramienta de mucho valor para la identificación del agente etiológico en NAV, especialmente cuando un broncoscopista experto o los recursos necesarios para lavado broncoalveolar guiado con broncoscopio no están fácilmente disponibles. Conclusions. The blind bronchoalveolar lavage with a modified nasogastric tube is a valuable tool for the identification of etiologic agent in VAPPALABRAS CLAVE: neumonía asociada a ventilador, lavado broncoalveolar, sonda nasogástrica, lavado broncoalveolar ciego.

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Section: Discussionmentioning

confidence: 61%

Comparison of Bronchoscopic Bronchoalveolar Lavage vs Blind Lavage With a Modified Nasogastric Tube in the Etiologic Diagnosis of Ventilator-Associated Pneumonia

Leos

Galindo-Galindo

Folch

et al. 2007

Chest

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“…Additionally, fiberoptic bronchoscopy may not be available 24 hours-aday in many ICUs. Therefore, research for easier and alternative techniques for the diagnosis of pneumonia is justified [6]. In conclusion, our findings suggest that the "blind" protected specimen brush has a similar diagnostic yield and specificity to bronchoscopic techniques.…”

Section: Discussionmentioning

confidence: 67%

“…Bronchoscopy with bronchoalveolar lavage (BAL) or protected specimen brush (PSB) has shown advantages in the diagnosis of pneumonia in patients on mechanical ventilation [6].…”

mentioning

confidence: 99%

Comparative study of etiological diagnosis of nosocomial pneumonia

Carvalho¹,

Massarollo²,

Levin

et al. 2008

Braz J Infect Dis

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Nosocomial pneumonia is a common complication in patients on mechanical ventilation and results in significant mortality. Diagnosis of pneumonia in patients who are intubated and under mechanical ventilation is difficult, even with the aid of clinical, laboratorial, and endoscopic tests. The objective of this study was to compare three methods of tracheal sputum collection in patients with a clinical and radiological diagnosis of pneumonia. Twenty-two patients with a clinical diagnosis of liver disease were enrolled, 18 years of age or older, 13 males and nine females, who had been mechanically ventilated over an intubation period of 5.86 ± 4.62 days. These patients were being treated in intensive care unit (ICU) of the Liver Transplantdepartment. Secretion collection was carried out according to a protocol with three distinct methods: endotracheal aspiration with a closed aspiration system, Bal cath and bronchoalveolar lavage. Of the 22 patients analyzed, 21 (95.4%) showed one or more infectious agent when the closed aspiration system was used. With the Bal cathâ collection, 19 patients (86.3%) had one or more infectious agents; in the collection by bronchoalveolar lavage, 10 patients (45.4%) presented one or more infectious agent. According to the laboratorial analysis, 14 different microorganisms were isolated, the most frequent of which were Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. We concluded that aspiration with the closed system produced the most effective results in comparison with those of bronchoalveolar lavage and the Bal cath® ® ® ® ®, and may be an acceptable method for diagnosing hospital-acquired pneumonia when no fiberoptic technique is available.

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“…Other devices similar to the PSB have been tested with comparable results. 78 The blind BAL method has also been tested by several authors using different approaches. These approaches use conventional 14 methods, protected catheters using mini-BAL procedures, 79 Swan-Ganz catheters, 80 or more recently, protected catheters that can be directed to one or the other side of the lungs depending on where the infiltrates are located.…”

Section: Blind Methodsmentioning

confidence: 99%