title: Blind protected specimen brush and bronchoalveolar lavage in ventilated children.
abstract: OBJECTIVE
  To determine whether nonbronchoscopic protected specimen brush (PSB) and bronchoalveolar lavage (BAL) are contributive for diagnosing ventilator-associated pneumonia in mechanically ventilated children.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Fifteen-bed pediatric intensive care unit in a university hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service de Réanimation Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Labenne
authors.forename: C
authors.initials: C
authors.lastname: Poyart
authors.forename: C
authors.initials: C
authors.lastname: Rambaud
authors.forename: B
authors.initials: B
authors.lastname: Goldfarb
authors.forename: B
authors.initials: B
authors.lastname: Pron
authors.forename: P
authors.initials: P
authors.lastname: Jouvet
authors.forename: C
authors.initials: C
authors.lastname: Delamare
authors.forename: G
authors.initials: G
authors.lastname: Sebag
authors.forename: P
authors.initials: P
authors.lastname: Hubert
mesh_terms: D001419:Bacteria / Q000302:isolation & purification; D001706:Biopsy; D018893:Bronchoalveolar Lavage / Q000379:methods*; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004869:Equipment Safety; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008168:Lung / Q000382:microbiology / Q000473:pathology; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000009:adverse effects*; D013048:Specimen Handling / Q000295:instrumentation*