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

Abstract

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.

Statement of the 4th International Consensus Conference in Critical Care on ICU-Acquired Pneumonia – Chicago, Illinois, May 2002

“…Non-bronchoscopic techniques such as blinded sampling with a PSB or mini-BAL have been developed [150,151,152]. These techniques have similar diagnostic accuracy as bronchoscopic techniques, but carry a slightly lower specificity [145].…”

Diagnosis and treatment of nosocomial pneumonia in ALI/ARDS patients

“…Acceptable results were obtained with these techniques by several investigators. Protected telescoping catheter, mini-BAL or protected mini-BAL, performed blindly, gave results similar to those obtained with the PSB techniques [38,39]. However, the overall concordance between blinded and bronchoscopic techniques was only y80%, suggesting that the diagnosis could be missed, particularly in the case of pneumonia involving the left lung and/or the upper lobes [35,40].…”

Resultados preliminares y factibilidad del mini lavado bronco-alveolar en pacientes cursando falla respiratoria severa

“…El uso de esta técnica ha sido publicado en la literatura y alcanza una sensibilidad y especifi cidad de 70% y 90%, respectivamente, valores comparables a los obtenidos en el LBA por FBC 18 . El mini BAL tiene la ventaja de ser simple, tener un menor costo y puede ser realizado por el mismo personal de la unidad de cuidados intensivos (UCI), una vez entrenados.…”