Diagnosis of nosocomial pneumonia in mechanically ventilated patients by the blind protected telescoping catheter.
OBJECTIVE
To demonstrate that blind insertion of the protected telescoping catheter (PTC-NB) through the orotracheal tube can provide reliable pulmonary samples for the diagnosis of nosocomial pneumonia (NP) in ventilated patients.


METHODS
We performed a random comparison between the protected telescoping catheter introduced through a bronchofiberscope (PTC-B) and the PTC-NB to diagnose NP.


METHODS
A general intensive care unit of a University Hospital.


METHODS
40 consecutive patients on mechanical ventilation and with suspicion of NP. The diagnosis of NP was suspected by clinical and chest X-ray findings.


RESULTS
NP was confirmed microbiologically in 26 (65%) patients and maintained in 8 patients by clinical and radiological criteria. PTC-NB confirmed the microbiological diagnosis of PN in 21 (80%) patients. The use of antibiotics prior taking respiratory samples reduced the sensitivity of PTC-NB and PTC-B from 100-74% and from 94-70% (p = 0.001). Both techniques agreed in 24 of 33 (73%) patients but such agreement was better when PN was on the right lung. Two patients developed a self-limiting hemoptysis after the PTC-B procedure.


CONCLUSIONS
PTC-NB is as sensitive as specific as PTC-B for diagnosing PN in mechanically ventilated patients, being a much easier technique to use.
Jordá
R
R
Intensive Care Unit, University Hospital Son Dureta, Palma de Mallorca, Spain.
Parras
F
F
Ibañez
J
J
Reina
J
J
Bergadá
J
J
Raurich
J M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy / Q000379:methods; D003428:Cross Infection / Q000175:diagnosis* / Q000209:etiology* / Q000382:microbiology; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology* / Q000382:microbiology; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D011897:Random Allocation; D012121:Respiration, Artificial / Q000009:adverse effects*; D013211:Staphylococcus aureus / Q000302:isolation & purification