title: Non-bronchoscopic bronchoalveolar lavage in the microbiological diagnosis of pneumonia in mechanically ventilated patients.
abstract: A prospective study comparing standardized non-bronchoscopic bronchoalveolar lavage (sNB-BAL) and non-specific endotracheal aspirate (NsETA) in the microbiological diagnosis of pneumonia in mechanically ventilated patients is described. One hundred episodes in 82 mechanically ventilated patients with or without radiological and clinical diagnostic criteria of pneumonia were studied. NsETA and sNB-BAL was performed on the day of study. Fifty-one patients had pneumonia (21 ventilator-associated, 12 hospital-acquired, 18 community-acquired) and 49 had no pneumonia as defined by widely accepted clinico-radiological criteria. The sNB-BAL was found to be significantly more specific (0. 73) compared to NsETA (0.35) for the microbiological diagnosis of pneumonia. Colonization rates with NsETA were significantly higher compared to sNB-BAL (P value <0.0001). No patient had complications attributable to the sNB-BAL procedure. We conlude that sNB-BAL is a safe, effective, sensitive, specific and inexpensive procedure for the serial evaluation of pneumonia in mechanically ventilated patients.
authors.affiliation: Department of Intensive Care, Westmead Hospital, Sydney, New South Wales.
authors.forename: S C
authors.initials: SC
authors.lastname: Arora
authors.forename: Y M
authors.initials: YM
authors.lastname: Mudaliar
authors.forename: C
authors.initials: C
authors.lastname: Lee
authors.forename: D
authors.initials: D
authors.lastname: Mitchell
authors.forename: J
authors.initials: J
authors.lastname: Iredell
authors.forename: R
authors.initials: R
authors.lastname: Lazarus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018893:Bronchoalveolar Lavage / Q000379:methods*; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000209:etiology; D003428:Cross Infection / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D014132:Trachea / Q000382:microbiology