title: Reliability of mini-bronchoalveolar lavage for the measurement of epithelial lining fluid concentrations of tobramycin in critically ill patients.
abstract: 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.
authors.affiliation: Hôpital Edouard Herriot, Department of Anesthesiology and Intensive Care, 5 place d'Arsonval, 69003 Lyon, France. emmanuel.boselli@chu-lyon.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boselli
authors.forename: Dominique
authors.initials: D
authors.lastname: Breilh
authors.forename: Sarah
authors.initials: S
authors.lastname: Djabarouti
authors.forename: Christian
authors.initials: C
authors.lastname: Guillaume
authors.forename: Thomas
authors.initials: T
authors.lastname: Rimmelé
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Gordien
authors.forename: Fabien
authors.initials: F
authors.lastname: Xuereb
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Saux
authors.forename: Bernard
authors.initials: B
authors.lastname: Allaouchiche
mesh_terms: 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*
chemical_list: D000900:Anti-Bacterial Agents; D014031:Tobramycin