Blind protected specimen brush and bronchoalveolar lavage in ventilated children
| Autor: | Claire Poyart, Marc Labenne, Guy Sebag, Catherine Delamare, Philippe Hubert, Bernard Goldfarb, Caroline Rambaud, Philippe Jouvet, Bénédicte Pron |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Male
Artificial ventilation medicine.medical_specialty Biopsy medicine.medical_treatment Intensive Care Units Pediatric Critical Care and Intensive Care Medicine Bronchoalveolar Lavage Specimen Handling Diagnosis Differential Hospitals University Bronchoscopy Intensive care Pneumonia Bacterial medicine Humans Prospective Studies Child Lung Mechanical ventilation Pediatric intensive care unit Bacteria Equipment Safety medicine.diagnostic_test business.industry Infant Newborn Infant Reproducibility of Results respiratory system medicine.disease Respiration Artificial respiratory tract diseases Surgery Pneumonia Bronchoalveolar lavage Child Preschool Protected specimen brush Female business Bronchoalveolar Lavage Fluid |
| Zdroj: | Critical Care Medicine. 27:2537-2543 |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/00003246-199911000-00035 |
| Popis: | To determine whether nonbronchoscopic protected specimen brush (PSB) and bronchoalveolar lavage (BAL) are contributive for diagnosing ventilator-associated pneumonia in mechanically ventilated children.Prospective study.Fifteen-bed pediatric intensive care unit in a university hospital.A total of 103 mechanically ventilated children, ranging in age from 7 days to 8.8 yrs, most with a high clinical suspicion for bacterial pneumonia.All the children underwent nonbronchoscopic PSB and BAL. Nonbronchoscopic PSB was performed with a plugged double-sheathed brush and BAL with a double-lumen plugged catheter. Endotracheal secretions and blood cultures were also collected. Open-lung biopsy was performed for any child who died within 7 days after the inclusion in the study, according to the parental consent.The PSB specimens were submitted for bacteriologic quantitative culture (positive threshold, 10(3) colony-forming units [cfu]/mL). The BAL samples were processed for microscopic quantification of the polymorphonuclear cells containing intracellular bacteria (positive threshold, 1%) and quantitative culture (positive threshold, 10(4) cfu/mL). According to diagnostic categories based on clinical, biological, radiologic, and pathologic criteria, 29 children had bacterial pneumonia and 64 did not Ten children were classified as having an uncertain status. Of the 29 children with bacterial pneumonia, 26 (90%) met one of the following three criteria: a) PSB specimen culture,or =10(3) cfu/mL; b) intracellular bacteria in cells retrieved by BAL,or =1%; and c) BAL fluid culture,or =10(4) cfu/mL. In contrast, 56 (88%) of the 64 patients without pneumonia did not.The results of this study indicate the following: a) nonbronchoscopic PSB and BAL were feasible in a large population of mechanically ventilated children; b) nonbronchoscopic techniques were contributive for diagnosing ventilator-associated pneumonia in children; and c) a combined diagnostic approach, using nonbronchoscopic PSB and BAL, was superior to using either test alone. |
| Databáze: | OpenAIRE |
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