Reliability of mini-bronchoalveolar lavage for the measurement of epithelial lining fluid concentrations of tobramycin in critically ill patients.
OBJECTIVE
To evaluate the reliability of mini-bronchoalveolar lavage (mini-BAL) for the measurement of tobramycin concentrations in epithelial lining fluid (ELF) in comparison with conventional bronchoscopic bronchoalveolar lavage (BAL).


METHODS
Prospective, open-label study.


METHODS
An intensive care unit and research ward in a university hospital.


METHODS
Twelve critically ill adult patients with ventilator-associated pneumonia (VAP).


METHODS
All subjects received intravenous infusions of tobramycin 7-10 mg/kg once daily. After 2 days of therapy, the steady-state serum and ELF concentrations (obtained from BAL and mini-BAL) of tobramycin were determined by means of high-performance liquid chromatography.


RESULTS
We observed poor penetration of tobramycin in ELF of approximately approximately 12% with ELF peak concentrations of approximately approximately 3 mg/l with both methods. Good agreement in Bland-Altman analysis (mean +/- SD bias = 0.04 +/- 0.38 mg/l) was observed between the two methods of sampling.


CONCLUSIONS
Our results suggest that tobramycin 7-10 mg/kg once daily in critically ill patients with VAP might provide insufficient lung concentrations in the case of difficult-to-treat pathogens. Besides, mini-BAL, which is simple, non-invasive and easily repeatable at the bedside, appears to be a reliable method for the measurement of antibiotic concentrations in ELF in comparison with bronchoscopic BAL in critically ill patients with VAP.
Boselli
Emmanuel
E
Hôpital Edouard Herriot, Department of Anesthesiology and Intensive Care, 5 place d'Arsonval, 69003 Lyon, France. emmanuel.boselli@chu-lyon.fr
Breilh
Dominique
D
Djabarouti
Sarah
S
Guillaume
Christian
C
Rimmelé
Thomas
T
Gordien
Jean-Baptiste
JB
Xuereb
Fabien
F
Saux
Marie-Claude
MC
Allaouchiche
Bernard
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000032:analysis / Q000493:pharmacokinetics*; D018893:Bronchoalveolar Lavage; D002851:Chromatography, High Pressure Liquid; D016638:Critical Illness; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy; D011446:Prospective Studies; D015203:Reproducibility of Results; D020545:Respiratory Mucosa / Q000378:metabolism*; D014031:Tobramycin / Q000008:administration & dosage / Q000032:analysis / Q000493:pharmacokinetics*
D000900:Anti-Bacterial Agents; D014031:Tobramycin