Diagnostic Value of Telescoping Plugged Catheters in Mechanically Ventilated Patients with Bacterial Pneumonia Using the Metras Catheter

Torres, Antoni; J, Puig de la Bellacasa; Rodríguez-Roisín, Robert; Anta, Jiménez de; Agustí-Vidal, A

doi:10.1164/ajrccm/138.1.117

Cited by 150 publications

(60 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…(lung biopsy and blood culture) have some limitations in their specificity [23]. As it is difficult to establish in practice a diagnosis of true VAP, most of the published studies have been made in patients with suspected VAP based on clinical criteria [9][10][11][12][13][14][24][25][26][27][28][29][30], as we did in our study. Some microorganisms, especially Haemophilus influenzae, Streptococcus pneumoniae, L. pneumophila and anaerobic bacteria, are very sensitive to saline transport media, and their concentrations decrease from 97 to 45% after one hour of exposure [31].…”

Section: Discussionmentioning

confidence: 99%

“…ZUCKER et al [9] first described this type of bronchial brushing in a small infant population. TORRES et al [10] then assessed the usefulness of bronchial brushing through a Métras catheter. MIDDLETON et al [11] first compared the accuracy of PSB-nonBF (Accu-Cath) with PSB-BF, blind endotracheal aspiration, and BAL in 12 patients with ventilator-associated pneumonia (VAP), and found a similar recovery of bateria using these four methods [11].…”

mentioning

confidence: 99%

See 1 more Smart Citation

"Blind" protected specimen brushing <I>versus</I> bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia

Bello

Tajada²,

Chacón³

et al. 1996

European Respiratory Journal

View full text Add to dashboard Cite

The aetiological diagnosis of nosocomial pneumonia in intensive care unit (ICU) patients requires a valid, cheap and safe method. This method should be suitable for all mechanically-ventilated patients and all ICUs. The aim of this study was to assess the diagnostic yields of three methods: "blind" bronchial brushing (Accu-Cath)(protective specimen brush-nonbronchofibroscopic (PSB-non BF)); bronchofibroscopic protected specimen brushing (PSB-BF) and bronchoalveolar lavage (BAL).We prospectively studied the diagnostic values of the three methods as well as the agreement between microbiological results in 74 patients with 88 episodes of clinically suspected ventilator-associated pneumonia (VAP) and 22 control subjects. VAP episodes were also divided into those with (n=24) and without antibiotic pretreatment (n=64), and into those with (n=78) and without (n=10) right lower lobe infiltrates on chest radiography.No differences were found as regards the bacteriological yield of the three techniques. Furthermore, the rate of concordant results was high; 92% for PSB-BF and BAL; 84% for PSB-nonBF and BAL; 85% for PSB-nonBF and PSB-BF; and 85% for PSB-nonBF combined with both bronchoscopic techniques. The diagnostic yields in suspected VAP were 66, 59 and 56% for PSB-nonBF, PSB-BF and BAL, respectively.We conclude that "blind" bronchial brushing has similar accuracy to bronchoscopic techniques commonly used in the diagnosis of ventilator-associated pneumonia, constituting an interesting alternative in hospitals where fibreoptic bronchoscopy is not available.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

"Blind" protected specimen brushing <I>versus</I> bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia

Bello

Tajada²,

Chacón³

et al. 1996

European Respiratory Journal

View full text Add to dashboard Cite

show abstract

“…Nevertheless, the sensitivity reported by several studies [7,35,38,43,48, 56±60] ranged 74±97% for BBS, 63±100% for mini-BAL and 58±86% for BPSB. Speci®city appears to be similar to ®breoptic bronchoscope techniques (PSB and BAL) and ranges 74±100% for BBS, 66±96% for mini-BAL and 71±100% for BPSB.…”

Section: Nonbronchoscopic Techniquesmentioning

confidence: 97%

“…PSB may cause bleeding, particularly in patients with renal failure and coagulopathies, and sometimes pneumothorax [24,33,48]. The complications of BAL include declines in arterial oxygen tension (Pa,O 2 ), slight rises in arterial carbon dioxide tension (Pa,CO 2 ), fever, transient worsening in pulmonary in®ltrates, sepsis-like effect (accounted to a bacterial translocation from alveoli to the systemic circulation) [49], arrhythmia and, rarely, pneumothorax, haemoptysis, exacerbation of respiratory failure, and transient increase in lung vascular permeability [50].…”

Section: Bronchoscopic Techniquesmentioning

confidence: 99%

Microbial investigation in ventilator-associated pneumonia

Ioanăş¹,

Ferrer²,

Angrill³

et al. 2001

Eur Respir J

View full text Add to dashboard Cite

Ventilator-associated pneumonia (VAP) is a serious infectious condition in intensive care unit (ICU) patients, currently related to a high mortality rate. Therefore, this complication of mechanical ventilation requires a prompt diagnosis and adequate antibiotic treatment. The detection of the causative organism is imperative for guiding an appropriate therapy as there is strong evidence of the adverse effect of inadequate empirical treatment on outcome. The major difficulty of the microbial investigation is to obtain the sample from the lower respiratory tract, mainly because of the potential contamination with upper airways flora, which may result in a misinterpretation of the cultures.Microbial investigation in VAP is based on the culture of samples obtained from lower respiratory tract by noninvasive or invasive methods. The most common techniques of sampling are the endotracheal aspirate (ETA), which is considered a noninvasive method, the protected specimen brush (PSB) and the bronchoalveolar lavage (BAL), both being invasive methods of investigation. The latter were designed as an attempt to avoid the colonizing flora of the upper airways. The best of these diagnostic approaches is still controversial. In terms of outcome, there is strong evidence that the impact of both invasive and noninvasive methods seems to be similar. In terms of cost, however, the endotracheal aspirate is less expensive compared to BAL or PSB. On the other hand, invasive methods could be particularly beneficial in patients who are not responding to the initial empirical antibiotic treatment.The rationale for the quantitative culture of the respiratory samples is to differentiate between infection and colonization of lower airways, because the bacterial colonization is a frequent event in mechanically ventilated patients. The thresholds currently employed for the diagnosis of the pneumonia are the following: ETA samples, ≥105–106colony forming units (cfu)·mL−1; PSB samples, ≥103cfu·mL−1; and BAL samples, ≥104 cfu·mL−1.Intending to provide a practical approach to the issue, the present manuscript reviews the available noninvasive (blood culture, endotracheal aspirate) and invasive (protected specimen brush, bronchoalveolar lavage, blinded methods and lung biopsy) techniques used for the diagnosis of ventilator-associated pneumonia.

show abstract

“…Furthermore, noninvasive techniques are preferably indicated in patients with severe bleeding disorders or with septic shock. Studies confirming the value of nonbronchoscopic techniques, therefore, prove to be of high clinical interest [7,8,16,[26][27][28][29][30][31]. Bronchoscopy, on the other hand, offers the advantage of revealing important additional diagnostic information by direct visualization of the tracheobronchial tree, e.g.…”

Section: Editorialmentioning

confidence: 99%

Diagnosis of ventilator-associated pneumonia: nonroutine tools for routine practice

Ewig¹

1996

European Respiratory Journal

View full text Add to dashboard Cite

Diagnostic Value of Telescoping Plugged Catheters in Mechanically Ventilated Patients with Bacterial Pneumonia Using the Metras Catheter

Cited by 150 publications

References 3 publications

"Blind" protected specimen brushing <I>versus</I> bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia

"Blind" protected specimen brushing <I>versus</I> bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia

Microbial investigation in ventilator-associated pneumonia

Diagnosis of ventilator-associated pneumonia: nonroutine tools for routine practice

Contact Info

Product

Resources

About