Comparative Efficacy of Bronchoalveolar Lavage and Telescoping Plugged Catheter in the Diagnosis of Pneumonia in Mechanically Ventilated Patients

Violan, J. Sole; Castro, Felipè Rodríguez de; Luna, J.; Benítez, Ana Bordes; Alonso, José Luis

doi:10.1378/chest.103.2.386

Cited by 51 publications

(12 citation statements)

References 16 publications

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“…Clinical criteria alone may not be sufficiently reliable (5,6). Over the years, new invasive diagnostic techniques such as bronchoscopic bronchoalveolar lavage (BAL) and protected specimen brush have been studied and are now widely used in adults (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In the pediatric population, there is no accepted standard besides autopsy for the diagnosis of VAP.…”

mentioning

confidence: 99%

Ventilator-associated pneumonia in intubated children: Comparison of different diagnostic methods*

Gauvin

Dassa

Cha??bou

et al. 2003

Pediatric Critical Care Medicine

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Studies on head injury-induced pituitary dysfunction are limited in number and conflicting results have been reported. To further clarify this issue, 29 consecutive patients (24 males), with severe (n = 21) or moderate (n = 8) head trauma, having a mean age of 37 ± 17 years were investigated in the immediate post-trauma period. All patients required mechanical ventilatory support for 8-55 days and were enrolled in the study within a few days before ICU discharge. Basal hormonal assessment included measurement of cortisol, corticotropin, free thyroxine (fT4), thyrotropin (TSH), testosterone (T) in men, estradiol (E2) in women, prolactin (PRL), and growth hormone (GH). Cortisol and GH levels were measured also after stimulation with 100 µg human corticotropin releasing hormone (hCRH) and 100 µg growth hormone releasing hormone (GHRH), respectively. Cortisol hyporesponsiveness was considered when peak cortisol concentration was less than 20 µg/dl following hCRH. TSH deficiency was diagnosed when a subnormal serum fT4 level was associated with a normal or low TSH. Hypogonadism was considered when T (males) or E2 (women) were below the local reference ranges, in the presence of normal PRL levels. Severe or partial GH deficiencies were defined as a peak GH below 3 µg/l or between 3 and 5 µg/l, respectively, after stimulation with GHRH. Twenty-one subnormal responses were found in 15 of the 29 patients (52%) tested; seven (24%) had hypogonadism, seven (24%) had cortisol hyporesponsiveness, five (17%) had hypothyroidism, and two patients (7%) had partial GH deficiency.These preliminary results suggest that a certain degree of hypopituitarism occurs in more than 50% of patients with moderate or severe head injury in the immediate post-trauma period, with cortisol hyporesponsiveness and hypogonadism being most common. Further studies are required to elucidate the pathogenesis of these abnormalities and to investigate whether they affect long-term morbidity. P2Cortisol reserve in head trauma victims: evaluation with the low-dose (1 µ µg) corticotropin (ACTH) stimulation test To investigate cortisol reserve in head trauma, 35 consecutive patients (30 men) with a mean age of 36 ± 16 years were studied 5-60 days after physical injury. Patients were enrolled in the study within a few days before ICU discharge. First, a morning blood sample was obtained to measure baseline cortisol, and ACTH plasma levels. Subsequently, 1 µg synthetic ACTH was injected intravenously and, 30 min later, a second blood sample was drawn to determine stimulated plasma cortisol. Patients having stimulated cortisol levels below 18 µg/dl were defined as nonresponders to the low-dose stimulation test (LDST). Mean (± SD) values for ACTH, baseline, and stimulated cortisol concentrations were 49 ± 27 pg/ml, 19.7 ± 5.5 µg/dl and 23.6 ± 6.7 µg/dl, respectively. Six of the 35 patients (17%) failed the LDST. Nonresponders were similar to responders with regard to age, gender, and severity of head injury. However, nonresponders more frequently required vasopres...

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Ventilator-associated pneumonia in intubated children: Comparison of different diagnostic methods*

Gauvin

Dassa

Cha??bou

et al. 2003

Pediatric Critical Care Medicine

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“…After incubation, the colonies are counted on the plates and the number of CFU per milliliter is determined by multiplying the number of colonies by the dilution factor. Calibrated loops are widely used for quantitative BAL fluid cultures in the diagnostic and research settings (4,7,8,11,12,19,20,21,23).…”

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Accuracy and Precision of Quantitative Calibrated Loops in Transfer of Bronchoalveolar Lavage Fluid

Jacobs¹,

Brauwer²,

Cornelissen³

et al. 2000

J. Clin. Microbiol.

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Quantitative cultures of bronchoalveolar lavage (BAL) fluid are important in the diagnosis of ventilatorassociated pneumonia, and calibrated loops are commonly used to set up these cultures. In this study, the performances of calibrated 0.010-and 0.001-ml loops in the transfer of BAL fluid were determined. Five loops of one lot from seven manufacturers were tested. Calibrations were performed by the gravimetric method (0.010-ml loops) and the colorimetric method (0.001-ml loops). Most of the 0.010-ml loops displayed a precision that was less than 10%, but six of them showed very poor accuracies as they transferred a deficiency (nichrome loops) or an excess (disposable loops) of BAL fluid that exceeded ؎10%. The mean maximum and minimum BAL fluid volumes delivered by the 0.010-ml loops differed by a factor 3. The 0.001-ml loops displayed acceptable precision. Five of them showed inaccuracies of <؎10%, and mean maximum and minimum BAL fluid volumes had a range of a factor of 2. For all loops, the volumes of BAL fluid sampled were larger than the volumes of reagent-grade water sampled. Results of the colony counting experiments confirmed these findings and revealed a high intra-assay variability for the 0.001-ml loops. We conclude that, when BAL fluid samples are cultured with calibrated loops, (i) proper verification of the calibration of these loops is mandatory, (ii) calibrations should be performed with BAL fluid as the test solution, and (iii) borderline quantitative culture results should be interpreted with knowledge of the inaccuracy values of these loops.

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“…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).…”

Section: Discussionunclassified

“…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.…”

Section: Discussionunclassified

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

et al. 2008

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Introducción. El diagnóstico microbiológico de la neumonía permite optimizar el uso de antibióticos en pacientes con asistencia respiratoria mecánica. Para ello se han cultivado cuantitativamente las muestras del lavado broncoalveolar broncoscópico, procedimiento que no siempre es posible. Objetivo. Evaluar la concordancia microbiológica entre muestras respiratorias tomadas por lavado broncoalveolar broncoscópico y no broncoscópico, y establecer si el uso previo de antibióticos y el momento de presentación de la neumonía pueden afectarla. Materiales y métodos. Estudio prospectivo realizado en el Hospital Universitario San Vicente de Paúl, en 38 pacientes con sospecha de neumonía y con asistencia respiratoria mecánica. En todos se practicó el lavado broncoalveolar por fibrobroncoscopia y el lavado no broncoscópico usando un catéter telescopado de punta preformada (Balcath®). Todas las muestras fueron procesadas siguiendo protocolos microbiológicos convencionales. Resultados. Considerando el lavado broncoalveolar por fibrobroncoscopia como patrón de referencia, los cultivos permitieron identificar el agente en 60,5% de los casos. El acuerdo diagnóstico se logró en 82% de los pacientes y 79% de los aislamientos. Utilizando el índice kappa de Cohen, la concordancia general entre los dos métodos fue 0,76 [0,93]; pero en quienes habían recibido antibióticos previos fue 0,26 [0,05-0,48], versus 1,0 en quienes no lo habían hecho (p<0,0001). La concordancia no difirió significativamente cuando se compararon los casos de neumonía temprana y tardía. Conclusiones. La concordancia general entre los dos métodos de lavado broncoalveolar es buena en pacientes con neumonía y respiración asistida mecánicamente. Sin embargo, el uso previo de antibióticos y no el momento de aparición de la neumonía, disminuye ésta significativamente.Palabras clave: neumonía/etiología, respiración artificial, técnicas y procedimientos diagnósticos, técnicas microbiológicas, lavado broncoalveolar. Concordance between two methods of bronchoalveolar lavage for the microbiological diagnosis of pneumonia in mechanically ventilated patientsIntroduction. Microbiological diagnosis of pneumonia allows the optimal use of antibiotics in mechanically ventilated patients. That is why samples of bronchoscopic bronchoalveolar lavage had been quantitatively cultivated, but this procedure is not always possible. Objective. To evaluate the microbiological concordance between respiratory samples obtained by non-bronchoscopic protected bronchoalveolar lavage compared to the bronchoscopic ones, and to find out whether concordance was affected by previous use of antibiotics or the time of pneumonia onset.

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Comparative Efficacy of Bronchoalveolar Lavage and Telescoping Plugged Catheter in the Diagnosis of Pneumonia in Mechanically Ventilated Patients

Cited by 51 publications

References 16 publications

Ventilator-associated pneumonia in intubated children: Comparison of different diagnostic methods*

Ventilator-associated pneumonia in intubated children: Comparison of different diagnostic methods*

Accuracy and Precision of Quantitative Calibrated Loops in Transfer of Bronchoalveolar Lavage Fluid

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

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