Conditional evaluation of broncho-alveolar lavage in mechanically ventilated patients with suspected unilateral lobar pneumonia.
OBJECTIVE
In an attempt to improve our ability to diagnose the cause of ventilator-associated pneumonia (VAP), we explore the usefulness of the conditional evaluation of bronchoalveolar lavage (BAL) samples from the involved and non-involved areas in patients with suspected unilateral lobar VAP (UL-VAP).


METHODS
Prospective study.


METHODS
University teaching hospital intensive care unit.


METHODS
We studied 19 consecutive patients with suspected UL-VAP.


RESULTS
Nine of the 12 patients (47%) developed UL-VAP. There was a significant difference between the involved and non-involved areas in UL-VAP patients (P < 0.001) in respect of the quantitative bacterial cultures (QBCs) of BAL samples for each micro-organism, whereas there was no difference in patients without UL-VAP. When we applied the criterion of usual BAL (one micro-organism in concentrations > 10(5) colony-forming units per millilitre) for UL-VAP diagnosis, the sensitivity was 100%, the specificity 70%, the positive predictive value 75%, and the negative predictive value 100%. When we used the conditional evaluation of the BAL results for UL-VAP diagnosis, in the involved and non-involved areas, the sensitivity was 78%, the specificity 90%, the positive predictive value 87.5% and the negative predictive value 82%. A statistically significant difference was found when we compared the difference in QBCs between the BAL samples for each micro-organism, between the involved and non-involved areas in patients with and without VAP (P < 0.001).


CONCLUSIONS
These data suggest that utilisation of the conditional evaluation of the QBCs of BAL samples improves significantly our ability to diagnose the cause of UL-VAP.
Prekates
A
A
Department of Critical Care, University of Athens Medical School, Greece.
Nanas
S
S
Nakos
G
G
Floros
J
J
Argyropoulou
A
A
Paniara
O
O
Roussos
C
C
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018893:Bronchoalveolar Lavage / Q000379:methods*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008168:Lung / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*
D000900:Anti-Bacterial Agents