Diagnosis of ventilator-associated pneumonia in children in resource-limited setting: a comparative study of bronchoscopic and nonbronchoscopic methods.
OBJECTIVE
To compare the available methods for the diagnosis of ventilator-associated pneumonia in intubated pediatric patients and to suggest less costly diagnostic method for developing countries.


METHODS
Prospective study.


METHODS
Pediatric intensive care unit of a tertiary care, multidisciplinary teaching hospital located in northern India.


METHODS
All consecutive patients on mechanical ventilation for >48 hrs were evaluated clinically for ventilator-associated pneumonia.


METHODS
Four diagnostic procedures (tracheal aspiration, blind bronchial sampling, blind bronchoalveolar lavage, and bronchoscopic bronchoalveolar lavage) were performed in the same sequence within 12 hrs of clinical suspicion of ventilator-associated pneumonia. The bacterial density > or =104 colony-forming units/mL in a bronchoscopic bronchoalveolar lavage sample was taken as reference standard.


RESULTS
Thirty patients with 40 episodes of ventilator-associated pneumonia were included in the study. Tracheal aspirate at the cutoff of > or =105 colony-forming units/mL was found to have sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 84%, 77%, 87.5%, 73%, and 80%, respectively. For blind bronchial sampling at > or =104 colony-forming units/mL cutoff, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 88%, 82%, 88%, 83%, and 87%, respectively; the most reliable results were obtained with blind bronchoalveolar lavage at the cutoff of > or =103 cfu/mL (sensitivity 96%, specificity 80%, positive predictive value 88%, negative predictive value 92%, and accuracy 90%). The area under the receiver operating characteristic curve of tracheal aspiration, blind bronchial sampling, and blind bronchoalveolar lavage was 0.87 +/- 0.06, 0.89 +/- 0.06, and 0.89 +/- 0.05, respectively. The cost of balloon-tip pressure catheter used for blind bronchoalveolar lavage was INR 1600.00 (US$40) whereas that for blind bronchial sampling was only INR 35.00 (<1 US$).


CONCLUSIONS
Blind bronchoalveolar lavage was the most reliable method followed closely by blind bronchial sampling for the diagnosis of ventilator-associated pneumonia. Considering the difference of the cost in the two procedures, blind bronchial sampling may be the preferred method in the pediatric intensive care unit of a developing country.
Sachdev
Anil
A
Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India. anilcriticare@hotmail.com
Chugh
Krishan
K
Sethi
Manpreet
M
Gupta
Dhiren
D
Wattal
Chand
C
Menon
Geetha
G
D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D019937:Diagnostic Techniques and Procedures; D005260:Female; D006295:Health Resources / Q000600:supply & distribution*; D006784:Hospitals, Teaching; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis*; D011446:Prospective Studies