Lavado broncoalveolar para el diagnóstico de neumonía en enfermos en ventilación mecánica

Estella, Ángel; Monge, Montserrat; Fontaiña, Luis Pérez; Baranda, Andrés Sainz de; Galán, M.J. Tello; Moreno, Elvira

doi:10.1016/s0210-5691(08)75718-8

Cited by 9 publications

(4 citation statements)

References 34 publications

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“…However, these are associated with false-positive and false-negative results. [18–20] Canadian Critical Care Trial group, in a large multicentric study, demonstrated that there was no difference in clinical outcome among patients treated for VAP based on bronchoscopic or non-bronchoscopic procedures. [21] Further, in developing countries like India, this facility is not routinely available for patients admitted to ICU.…”

Section: Discussionmentioning

confidence: 99%

Comparison of bronchoscopic and non-bronchoscopic techniques for diagnosis of ventilator associated pneumonia

Khilnani¹,

Arafath²,

Sood³

et al. 2011

Indian Journal of Critical Care Medicine

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Background:The diagnosis of ventilator associated pneumonia (VAP) remains a challenge because the clinical signs and symptoms lack both sensitivity and specificity and the selection of microbiologic diagnostic procedure is still a matter of debate.Aims and Objective:To study the role of various bronchoscopic and non-bronchoscopic diagnostic techniques for diagnosis of VAP.Settings and Design:This prospective comparative study was conducted in a medical ICU of a tertiary care center.Materials and Methods:Twenty-five patients, clinically diagnosed with VAP, were evaluated by bronchoscopic and non-bronchoscopic procedures for diagnosis. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of various bronchoscopic and non-bronchoscopic techniques were calculated, taking clinical pulmonary infection score (CPIS) of ≥6 as reference standard.Results:Our study has shown that for the diagnosis of VAP, bronchoscopic brush had a sensitivity, specificity, PPV and NPV of 94.9% [confidence interval (CI): 70.6–99.7], 57.1% (CI: 13.4–86.1), 85% (CI: 61.1–96) and 80% (CI: 21.9–98.7), respectively. Bronchoscopic bronchoalveolar lavage (BAL) had a sensitivity, specificity, PPV and NPV of 77.8% (CI: 51.9–92.6), 71.8% (CI: 24.1–94), 87.3% (CI: 60.4–97.8) and 55.5% (CI: 17.4–82.6), respectively. Sensitivity, specificity, PPV and NPV for non–bronchoscopic BAL (NBAL) were 83.3% (CI: 57.7–95.6), 71.43% (CI: 24.1–94), 88.2% (CI: 62.3–97.4) and 62.5% (CI: 20.2–88.2), respectively. Endotracheal aspirate (ETA) yield was only 52% and showed poor concordance with BAL (κ-0.351; P-0.064) and NBAL (k-0.272; P-0.161). There was a good microbiologic concordance among different bronchoscopic and non-bronchoscopic distal airway sampling techniques.Conclusion:NBAL is an inexpensive, easy, and useful technique for microbiologic diagnosis of VAP. Our findings, if verified, might simplify the approach for the diagnosis of VAP.

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Section: Discussionmentioning

confidence: 99%

Comparison of bronchoscopic and non-bronchoscopic techniques for diagnosis of ventilator associated pneumonia

Khilnani¹,

Arafath²,

Sood³

et al. 2011

Indian Journal of Critical Care Medicine

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“…Therefore, the mortality rates of VAP have been reported to range between 0 and 54% according to western as well as Indian data, 10 , 19 while in immunocompromised patients it is 73.3 to 76% as per the western literature. 20 , 21 …”

Section: Introductionmentioning

confidence: 99%

Microbiology of Ventilator-associated Pneumonia in a Tertiary Care Cancer Hospital

Sangale¹,

Bhat²,

Kelkar³

et al. 2021

Indian Journal of Critical Care Medicine

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A bstract Background Ventilator-associated pneumonia (VAP) is an important cause of healthcare-associated infections, resulting in prolonged hospitalization with increased morbidity and mortality. Knowledge of predominant local pathogens and their antimicrobial susceptibility patterns helps in selection of appropriate initial antibiotic therapy in these critical cases. Aim and objective The aim and objective of this study is to characterize the microbiology and antimicrobial susceptibility patterns of VAP isolates in a tertiary cancer center. Materials and methods This is a 4-year qualitative observational study carried out at a tertiary care cancer hospital in Mumbai. All nondirect bronchoalveolar lavage specimens from patients with a clinical suspicion of VAP sent from the critical care unit to the department of microbiology were processed as per standard laboratory procedures. All isolates were identified to species level and an antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion method and/or the VITEK 2 automated identification and susceptibility system, according to Clinical and Laboratory Standards Institute guidelines. Results The study comprised 1,074 patients: 710 (66.10%) men and 364 (33.90%) women. A total of 827 bacterial isolates were obtained with 780 (94.32%) gram-negative organisms and 47 (5.68%) gram-positive organisms; of which Acinetobacter baumannii (38.7%), Pseudomonas aeruginosa (17.5%), and Klebsiella pneumoniae (16.6%) were the commonest. Of gram-negative bacilli, multidrug-resistant organisms constituted 87.50% and were susceptible to colistin. Conclusions VAP is associated with pathogens, such as A. baumannii , P. aeruginosa, and K. pneumoniae in our setting. High rates of resistance to aminoglycosides, β-lactam-β-lactamase inhibitor combinations, and carbapenems were noted. How to cite this article Sangale A, Bhat V, Kelkar R, Biswas S. Microbiology of Ventilator-associated Pneumonia in a Tertiary Care Cancer Hospital. Indian J Crit Care Med 2021;25(4):421–428.

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“…Diagnosing the aetiology of suspected pneumonia in ICU patients is likely to help in the choice of antimicrobials that are used for treatment. In a study from Spain, conducted on mechanically ventilated patients of community-acquired and ventilator-associated pneumonia, the investigators found that BAL fluid was useful in diagnosing the aetiology of ventilator-associated pneumonia [ 13 ]. A retrospective study, conducted in China, observed a reduction in mortality among patients with ventilator-associated pneumonia who were subjected to bronchoscopy, compared to those who were not [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…BAL has been shown to have a better sensitivity and specificity than the Clinical Pulmonary Infection Score, which is based on readily available clinical, radiographic, and microbiological data [ 23 ]. Since there are studies in favour as well as against the use of BAL in ICU patients, the prudent approach may be to choose it as a diagnostic modality on a case-to-case basis, depending on the clinical setting and locally available resources [ 7 , 8 , 13 , 22 , 24 , 25 ]. In such a situation, the clinician's personal experience and preference also tend to play an important role in selecting a diagnostic modality.…”

Section: Discussionmentioning

confidence: 99%

Change in Antimicrobial Therapy Based on Bronchoalveolar Lavage Data Improves Outcomes in ICU Patients with Suspected Pneumonia

Chogtu,

Mariya Elenjickal,

Shetty

et al. 2023

Critical Care Research and Practice

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Flexible bronchoscopy (FB) is often performed in critically ill patients with suspected pneumonia. It is assumed that there will be an association with improved outcomes when bronchoalveolar lavage (BAL) data lead to a change in antimicrobial therapy. Methods. This study included a retrospective cohort of intensive care unit (ICU) patients who underwent FB for a diagnosis of suspected pneumonia. The study compared the outcome of patients in whom antimicrobial modification was carried out based on BAL reports versus those in whom it was not carried out. Cases where the procedure could not be completed or had incomplete records were excluded. The FB reports were accessed from the register maintained in the Department of Respiratory Medicine. The demographic details, clinical symptoms, laboratory investigations, and microbiological and radiology reports were recorded. Data on the antmicrobial therapy that the patients received during treatment and the outcome of the treatment were obtained from the case records and noted in the data collection form. Results. Data from a total of 150 patients admitted to the ICU, who underwent FB, were analyzed. The outcomes in the group where antimicrobial modification based on bronchoalveolar lavage (BAL) fluid reports was carried out versus the no-change group were as follows: expired 23, improved 82, unchanged 8 versus expired 12, improved 18, and unchanged 7 ( p = 0.018 ); total duration of ICU stay 13.12 ± 10.61 versus 19.43 ± 13.4 days ( p = 0.012 ); and duration from FB to discharge from ICU 6.33 ± 3.76 days versus 8.46 ± 5.99 ( p = 0.047 ). The median total duration of ICU stay and clinical outcomes were significantly better in the nonintubated patients in whom BAL-directed antimicrobial modification was implemented. Distribution of microorganisms based on BAL reports was as follows: Acinetobacter baumanii 45 (30%), Klebsiella pneumoniae 37 (24.66%), Escherichia coli 9 (6%), and Pseudomonas aeruginosa 9 (6%). Conclusion. A change in antimicrobial therapy based on BAL data was associated with improved outcomes. The commonest bacterial isolate in the BAL fluid was Acinetobacter baumanii.

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Lavado broncoalveolar para el diagnóstico de neumonía en enfermos en ventilación mecánica

Cited by 9 publications

References 34 publications

Comparison of bronchoscopic and non-bronchoscopic techniques for diagnosis of ventilator associated pneumonia

Comparison of bronchoscopic and non-bronchoscopic techniques for diagnosis of ventilator associated pneumonia

Microbiology of Ventilator-associated Pneumonia in a Tertiary Care Cancer Hospital

Change in Antimicrobial Therapy Based on Bronchoalveolar Lavage Data Improves Outcomes in ICU Patients with Suspected Pneumonia

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