Comparison between bronchoscopic BAL and non-bronchoscopic BAL in patients with VAP

Afify, Mohammad H.; Shaheen, Enas A.; El-Dahdouh, Samy S.; El-Feky, Hanady M.

doi:10.1016/j.ejcdt.2015.08.001

Cited by 17 publications

(25 citation statements)

References 36 publications

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“…Although insufficient data regarding the utility of Mini-BAL to TB diagnosis, some studies have applied the technique for the diagnosis of ventilator-associated pneumonia, including in immunocompromised patients [9,[19][20][21][22]. In addition, Mini-BAL was used for the biomarker identification in patients with lung injury [13], evaluated inflammation in patients with acute hypoxemic respiratory failure [14], cytological diagnosis of interstitial disorders with ARF and MV [23], concentration and absorption of antibiotics [24] and the safety and diagnostic accuracy of transbronchial biopsy [25].…”

Section: Discussionmentioning

confidence: 99%

The role of mini-bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis in critically ill patients

et al. 2020

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Background: The detection of Mycobacterium tuberculosis (MTB) in the intensive care unit (ICU) presents several challenges, mainly associated to the clinical state of the patient. The presence of HIV infection further aggravates this scenario, requiring a reliable collection method, with better performance in the microbiological/molecular techniques to be used. We evaluated the performance of two methods for sample collection, mini bronchoalveolar lavage (Mini-BAL) and endotracheal aspirate (ETA), for diagnosis of pulmonary tuberculosis (PTB) in critically ill patients.Methods: This prospective study involved 26 HIV positive ICU internalized patients, with presumptive PTB who required mechanical ventilation. Two samples were obtained prospectively from 26 HIV ICU patients with presumptive PTB by Mini-BAL and ETA. The samples were processed for smear microscopy, Löwenstein-Jensen medium and the BACTEC Mycobacteria Growth Indicator Tube 960 system®. We define as confirmed PTB patients with positive MTB culture. Furthermore, all samples obtained through the Mini-BAL were analyzed by Xpert® MTB/RIF. Results: Our results demonstrated that the respiratory samples obtained by Mini-BAL were able to increase MTB detection in critically ill patients with presumptive PTB. The Mini-BAL allowed 30% increased recovery and guaranteed enough sample volume for processing in all methods. In addition, the larger volume of the samples obtained with this technique enabled the Xpert® MTB/RIF molecular test for diagnosis of TB. Conclusions:The Mini-BAL showed be an acceptable alternative to ETA in this population, since these critically ill and often-immunocompromised patients are more likely to develop complications related to invasive procedures.

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Section: Discussionmentioning

confidence: 99%

The role of mini-bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis in critically ill patients

et al. 2020

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“…TA, BBS, blind BAL, and bronchoscopic BAL apart from transient hypoxia in two patients with BBS technique, who recovered completely with short duration of positive pressure ventilation (PPV). In another recent study enrolling adult subjects, by Afify et al, non‐bronchoscopic BAL (NBAL) was associated with fewer episodes of hypoxemia than bronchoscopic BAL, which was statistically significant. There were more chances of arrhythmias, bleeding, and other complications with bronchoscope, though the results were statistically non‐significant.…”

Section: Introductionmentioning

confidence: 90%

“…There were more chances of arrhythmias, bleeding, and other complications with bronchoscope, though the results were statistically non‐significant. They concluded that NBAL is safe and acceptable alternative to bronchoscopy for the evaluation of suspected VAP as NBAL is an inexpensive useful technique with good microbiologic concordance . There are always chances of pyrogenic effects due to instillation of saline solution during bronchial sampling.…”

Section: Introductionmentioning

confidence: 99%

“…Children have smaller endotracheal tubes, lesser cardiovascular reserves, and are more prone to hemodynamic instability when compared to adult population. In view of limited literature support and scarce data, from pediatric population, on the safety profile of methods to obtain distal respiratory secretions, this study was carried out to assess the safety of BBS in children with VAP . The objective of the present study was to evaluate the safety profile of BBS technique in mechanically ventilated children with VAP.…”

Section: Introductionmentioning

confidence: 99%

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Safety profile of blind bronchial sampling—A prospective study in pediatric intensive care unit

Gupta

Sachdev

Gupta

et al. 2018

Pediatric Pulmonology

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“…To this end, great effort has been expended to generate standardized diagnostic algorithms. Some examples ( [27], Hospital in Europe Link for Infection Control through Surveillance (HELICS) [28], Johanson criteria [29], and others [30,31]. However, the criteria used to diagnose VAP vary widely, which impacts reports of incidence and outcomes.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Diagnostic Algorithms and Clinical Parameters to Diagnose Ventilator-Associated Pneumonia: A Prospective Observational Study

Rahimi–Bashar

Miller²,

Yaghoobi

et al. 2020

Preprint

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BACKGROUND: Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. METHODS: A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal cultures and serum procalcitonin values were obtained for each patient. RESULTS: Eighty-five patients were enrolled (VAP 45, controls 41), mean age 46.94±18.9 years with a male predominance (72.94%). Using HELICS as the reference standard, the true positive (TP; sensitivity) and false negative (FN; miss rate) rates were CDC/NHSN (TP 44%; FN 0%), CPIS (TP 43%; FN 1%), Johnson (TP 43%; FN 1%). The highest true negative rate was seen with CPIS. CPIS had the highest Youden index; CDC/NHSN had the lowest. The positive tracheal culture rate was 81.2%. The sensitivity for positive tracheal culture with the serum procalcitonin level >0.5 ng/ml was 51.8%. CDC/NHSN had the highest false positive correlation with tracheal aspirate cultures. CONCLUSION: VAP remains a considerable source of morbidity and mortality in modern ICUs. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS displayed greater diagnostic accuracy compared to CDC/NHSN and Johanson criteria. Accuracy was improved with the addition of serum procalcitonin >0.5 ng/ml, but not positive quantitative endotracheal aspirate culture.TRIAL REGISTRATION: Not indicated for this study type.

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Comparison between bronchoscopic BAL and non-bronchoscopic BAL in patients with VAP

Cited by 17 publications

References 36 publications

The role of mini-bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis in critically ill patients

The role of mini-bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis in critically ill patients

Safety profile of blind bronchial sampling—A prospective study in pediatric intensive care unit

A Comparison of Diagnostic Algorithms and Clinical Parameters to Diagnose Ventilator-Associated Pneumonia: A Prospective Observational Study

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