title: [Bronchoalveolar lavage for diagnosing pneumonia in mechanically ventilated patients].
abstract: OBJECTIVE
  To evaluate the diagnostic role of bronchoalveolar lavage (BAL) in mechanically ventilated patients with suspected pneumonia and to describe the clinical outcome in the different kinds of pneumonia in critically ill patients.
  
  
  METHODS
  Descriptive study.
  
  
  METHODS
  A 17-bed medical and surgical intensive care unit.
  
  
  METHODS
  Mechanically ventilated patients admitted to the ICU from November 2003 to March 2006 with suspected pneumonia who underwent bronchoscopy with BAL.
  
  
  METHODS
  BAL was performed by fiberoptic bronchoscopy with three aliquots of 50 ml sterile normal saline. Recovered BAL fluid was pro-cessed for microbiologic analysis.
  
  
  METHODS
  Age, APACHE II score within the first 24 hours of admission, time on mechanical ventilation, ICU length of stay, mortality, and isolated bacteria were analyzed.
  
  
  RESULTS
  A total of 96 cases of suspected pneumonia with BAL were recruited, including 4 groups: community associated pneumonia (CAP), 12 cases, early-onset ventilator-associated pneumonia (VAP), 26 cases, late-onset ventilator-associated pneumonia, 43 cases, and immunocompromised patients, 15 cases. BAL was positive (> 10000 ufc/ml) in 40 (41.7%) patients (2, 16, 17 and 5 patients with CAP, early-onset VAP, late-onset VAP and immunocompromised, respectively). Mortality was 33.3%, 26.9%, 25.6% and 73.3% in CAP, early-onset VAP, late-onset VAP and immunocompromised patients respectively.
  
  
  CONCLUSIONS
  The low incidence of positive BAL in the CAP group supports using BAL only for particularly severe, selected cases. Mortality was very high in the immunocompromised patients. In the light of our personal experience, BAL is most useful in the diagnosis of pneumonia in the group of patients with VAP.
authors.affiliation: Unidad de Cuidados Intensivos. Hospital del SAS de Jerez. Jerez. Cádiz. España.
authors.forename: A
authors.initials: A
authors.lastname: Estella
authors.forename: M I
authors.initials: MI
authors.lastname: Monge
authors.forename: L
authors.initials: L
authors.lastname: Pérez Fontaiña
authors.forename: A
authors.initials: A
authors.lastname: Sainz de Baranda
authors.forename: M J
authors.initials: MJ
authors.lastname: Galá
authors.forename: E
authors.initials: E
authors.lastname: Moreno
mesh_terms: D001992:Bronchoalveolar Lavage Fluid; D006801:Humans; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis*