Diagnostic Value of Bronchoscopy in Critically Ill Ventilated Patients with the Lower Respiratory Tract Infections: Role in Detecting Bronchial Microbial Patterns

Abstract

BACKGROUND: Flexible bronchoscopy is an essential tool in critical care medicine. It provides direct access to the lower airways for sampling bronchial and parenchymal tissues directly at the site of lung lesion. AIM: The aim of the study was to study the value of Broncho-Alveolar Lavage (BAL) using bronchoscopy in detecting the bronchial microbial patterns in patients with pneumonia and also, to study the effect of antibiotic upgrading according to BAL results on patients’ outcome. PATIENTS AND METHODS: Sixty patients who were admitted to critical care department and developed pneumonia and put on mechanical ventilator were included in the study consecutively. Clinical and laboratory data were recorded on admission. Clinical and laboratory data, CPIS, PSI, PIRO and IBMP-10 scores were recorded on admission. All patients had bronchoalveolar lavage after diagnosis of pneumonia was established. The BALF was sent for culture and sensitivity. RESULTS: From a total of 60 patients with VAP, 51.7% were males, the age was 59.6 ± 17.5 years, mortality rate was 86.7%. In the non-survival group, the PSI was 133.4 ± 29.4 (p = 0.836). The APACHE II was 18.8 ± 6.6 (p = 0.432), PIRO 1.5 ± 1.1 (p = 0.014), and IBMP – 10 2.3 ± 1.1 (p = 0.021); all were higher in the non-survival group. BAL can detect up to 90% of pathogens responsible for the infection in the lower respiratory tract, while sputum can detect only 55% with accuracy of 65% (p = 0.006). Our results suggest that BAL culture and sensitivity was superior to sputum culture and sensitivity in detecting microorganisms with none of them had statistically significant relation to survival. High PIRO and IBMP-10 scores were good predictors for high mortality unlike PSI or APACHE II. CONCLUSION: Broncho-Alveolar Lavage (BAL) using bronchoscopy can detect the bronchial microbial patterns and superior to sputum culture but has no impact on mortality.