Utility of bilateral bronchoalveolar lavage for the diagnosis of ventilator-associated pneumonia in critically ill surgical patients
| Autor: | Eric W. Mueller, Neil Ernst, Karyn L. Butler, Sha-Ron Jackson |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Male
Artificial ventilation medicine.medical_specialty Critical Illness medicine.medical_treatment Colony Count Microbial Risk Assessment Sensitivity and Specificity Cohort Studies Bronchoscopy Pneumonia Bacterial medicine Humans Hospital Mortality Probability Cross Infection medicine.diagnostic_test business.industry Incidence Respiratory disease Ventilator-associated pneumonia General Medicine Middle Aged bacterial infections and mycoses medicine.disease Respiration Artificial Survival Analysis respiratory tract diseases Discontinuation Surgery Intensive Care Units Pneumonia Bronchoalveolar lavage Surgical Procedures Operative Anesthesia Female business Chest radiograph Bronchoalveolar Lavage Fluid |
| Zdroj: | The American Journal of Surgery. 195:159-163 |
| ISSN: | 0002-9610 |
| DOI: | 10.1016/j.amjsurg.2007.09.030 |
| Popis: | Background Bronchoalveolar lavage (BAL) is recommended to facilitate the diagnosis of ventilator-associated pneumonia (VAP). It is unclear if bilateral sampling improves the accuracy of BAL. Methods Consecutive patients with clinical suspicion for VAP were analyzed. All patients underwent bilateral BAL. A threshold of >10 4 colony-forming units (cfu)/mL was diagnostic for VAP (VAP positive). Samples were concordant if the organism(s) and thresholds from both lungs were diagnostically consistent. Organisms ≤10 4 cfu/mL with growth on the contralateral sample >10 4 cfu/mL were considered false-negative samples. Results Between November 2005 and April 2006, 73 patients were considered clinically suspicious for VAP. Forty-four (60%) patients were VAP positive. Twenty-eight (64%) VAP patients had concordant samples. Overall, there were 15 false-negative samples. Sole use of the unilateral samples to guide treatment would have inappropriately directed antibiotic avoidance and/or discontinuation in 25% of VAP patients. Influence of the chest radiograph was equivocal because of the presence of bilateral infiltrates in 80% of discordant samples. Conclusions Bilateral BAL improves the accuracy of bronchoscopy in diagnosing VAP. Unilateral BAL may be insensitive in patients with clinically significant contralateral infection. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect