A Prospective Study of Protected Bronchoalveolar Lavage in the Diagnosis of Nosocomial Pneumonia

Rouby, Jean-Jacques; Rossignon, M. D.; Nicolas, M. H.; Lassale, E. Martin de; Cristin, Sophie; Grosset, J; Viars, P.

doi:10.1097/00000542-198911000-00010

Cited by 185 publications

(85 citation statements)

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“…mL -1 as the criteria for significant pathogens has proved to be a useful cut-off between pneumonia and not pneumonia in other studies [10,16] and represents the recommended cut-off for bronchoscopic BAL [11]. It has also been verified for nonbronchoscopic BAL [12,17]. Patients with >10,000 cfu .…”

Section: Resultsmentioning

confidence: 91%

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Ventilator associated pneumonia: quality of nonbronchoscopic bronchoalveolar lavage sample affects diagnostic yield

Baughman¹,

Spencer²,

Kleykamp³

et al. 2000

Eur Respir J

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The importance of predefined criteria for acceptable samples of respiratory therapists′ obtained lower respiratory samples were studied, using a nonbronchoscopic bronchoalveolar lavage (BAL) protocol for ventilated patients in the intensive care unit. Therapists were instructed and asked to follow guidelines for obtaining samples. Over one year, 219 samples were obtained by respiratory therapists. Of these, 115 were considered to be adequate samples using the following criteria: 60 mL of instilled volume, at least 5 mL of fluid aspirated, specimens sent for semiquantitative culture, a differential cell count of <5% bronchial epithelial cells. Overall, 52 samples grew one or more pathogen at >10,000 colony forming units (cfu)·mL‐1 of BAL. The most common pathogen was Staphylococcus aureus (S. aureus) (11 samples), although Gram‐negative bacilli were the single pathogen in 21 specimens. Of the 115 acceptable samples, 40 (35%) grew ≥1 pathogen at >10,000 cfu·mL‐1. For the 80 not acceptable samples which were sent for appropriate culture, 12 (15%) grew >10,000 cfu·mL‐1 BAL. This difference was significant (Chi‐squared=9.44, p<0.01). Nonbronchoscopic bronchoalveolar lavage can be safely performed by respiratory therapists′. The authors recommend that a protocol be used to evaluate the quality of a bronchoalveolar lavage sample in the same manner sputum samples are screened prior to interpretation.

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Section: Resultsmentioning

confidence: 91%

“…Samples with >5% epithelial cells should not be considered a true alveolar sample. Some groups have used cytologic evaluation in assessing their sample [14,17,36]. The widespread use of this guideline has been recommended when using invasive techniques to diagnose VAP [37].…”

Section: Discussionmentioning

confidence: 99%

Ventilator associated pneumonia: quality of nonbronchoscopic bronchoalveolar lavage sample affects diagnostic yield

Baughman¹,

Spencer²,

Kleykamp³

et al. 2000

Eur Respir J

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“…Protected distal aspiration was performed via a double polyethylene catheter (Combicath TM ; Plastimed, Saint-Leu-La-Foret, France), according to the technique described by PHAM et al [12]. Mini-bronchoalveolar lavage was performed using a double polyethylene catheter (Combicath TM ; Plastimed, Saint-Leu-La-Foret, France) according to the technique described by ROUBY et al [13]. A 20-mL aliquot of normal saline was injected via the internal catheter and at least 2-mL was aspirated for microbiological examination.…”

Section: Respiratory Samplingmentioning

confidence: 99%

“…A noninvasive strategy based on blind methods has also been proposed [9±11]. Among noninvasive sampling methods, some authors have proposed a protected telescoping catheter inserted blindly into the respiratory tract in order to avoid contamination of the sample with pathogens from the upper tracheobronchial tree [12,13]. A protected telescoping catheter can be used in two ways, either by simple distal protected aspiration or instillation of sterile saline, i.e.…”

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confidence: 99%

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Diagnostic accuracy of protected catheter sampling in ventilator-associated bacterial pneumonia

Papazian¹,

Thomas²,

Carret³

et al. 2000

Eur Respir J

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The aim of this study was to assess the accuracy of protected telescoping catheter performed using: 1) protected distal aspiration, or 2) protected mini-bronchoalveolar lavage for the diagnosis of ventilator-associated bacterial pneumonia. Twenty-seven patients who died after receiving mechanical ventilation for at least 72 h were included in a comparative prospective post-mortem study. The two microbiological sampling procedures were performed immediately after death. Surgical pneumonectomies and biopsies were performed within 30 min of death at the bedside for histological examination. The results of the two techniques were compared with histological post-mortem lung examination or biopsies. Histological examination of the parenchyma showed signs of pneumonia in 14 cases. Lung tissue culture was positive in nine of these 14 cases. When ventilator-associated bacterial pneumonia was defined by the association of histological signs and positive lung tissue culture the sensitivity was 78% for both sampling techniques, specificity was 86% for mini-bronchoalveolar lavage and 100% for protected distal aspiration (at a threshold of 1 x 10(3) cfu x mL(-1)). Both techniques protected the distal aspiration and mini-bronchoalveolar lavage, and provided good specificity with an acceptable sensitivity for the diagnosis of ventilator-associated bacterial pneumonia.

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Relationship of Microbiologic Diagnostic Criteria to Morbidity and Mortality in Patients With Ventilator-Associated Pneumonia

Brégeon

Papazian²,

Visconti³

et al. 1997

JAMA

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A Prospective Study of Protected Bronchoalveolar Lavage in the Diagnosis of Nosocomial Pneumonia

Cited by 185 publications

References 0 publications

Ventilator associated pneumonia: quality of nonbronchoscopic bronchoalveolar lavage sample affects diagnostic yield

Ventilator associated pneumonia: quality of nonbronchoscopic bronchoalveolar lavage sample affects diagnostic yield

Diagnostic accuracy of protected catheter sampling in ventilator-associated bacterial pneumonia

Relationship of Microbiologic Diagnostic Criteria to Morbidity and Mortality in Patients With Ventilator-Associated Pneumonia

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