Comparison of bronchoscopic bronchoalveolar lavage vs blind lavage with a modified nasogastric tube in the etiologic diagnosis of ventilator-associated pneumonia

Abstract

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.

Systematic review of studies investigating ventilator associated pneumonia diagnostics in intensive care

“…The methodology description was not described in detail in three papers [ 40 , 45 , 82 ] and the results of the study were not clearly presented in five papers [ 46 , 64 , 67 , 69 , 75 ]. There was a lack of certainty regarding the results of the study on 11 occasions [ 40 , 42 , 43 , 46 , 58 , 64 , 65 , 67 , 68 , 74 , 75 ]. CASP diagnostic study checklist guide was followed in assessing all points.…”

“…All studies were published between 2008 and 2018 with a wide geographical spread; four studies conducted in the UK [ 41 , 44 , 72 , 74 ], eight in the USA [ 40 , 45 , 47 , 50 , 56 , 62 , 67 , 75 ], seven in France [ 51 , 53 , 55 , 63 , 70 , 73 , 78 ], five in Netherland [ 48 , 61 , 66 , 77 , 79 ], three each in both China [ 52 , 65 , 68 ] and Turkey [ 43 , 46 , 82 ], two each in Egypt [ 49 , 76 ], Brazil [ 54 , 81 ], and Italy [ 71 , 83 ], and eight in other countries [ 42 , 57 – 60 , 64 , 69 , 80 ]. The median sample size was 180 recruited participants, with the 21 being the lowest [ 58 ] and 2080 being the highest number of participants [ 61 ] (see Tables 2 , 3 ).…”

“…The median sample size was 180 recruited participants, with the 21 being the lowest [ 58 ] and 2080 being the highest number of participants [ 61 ] (see Tables 2 , 3 ).…”

Ventilator-associated pneumonia

“…Leo et al [9 ] performed a prospective study to compare the results of blind lavage vs. bronchoscopic-guided BAL for the etiologic diagnosis of VAP. They included 25 patients and performed the blind sampling with a modified nasogastric tube.…”

Diretrizes para tratamento da sepse grave/choque séptico: abordagem do agente infeccioso - diagnóstico

“…(82)(83)(84) Semiquantitative tracheal suction material or bronchoscopic bronchial lavage fluid cultures are recommended, using different cutoff points.…”