title: Comparison of bronchoscopic and non-bronchoscopic techniques for diagnosis of ventilator associated pneumonia.
abstract: BACKGROUND
  The diagnosis of ventilator associated pneumonia (VAP) remains a challenge because the clinical signs and symptoms lack both sensitivity and specificity and the selection of microbiologic diagnostic procedure is still a matter of debate.
  
  
  OBJECTIVE
  To study the role of various bronchoscopic and non-bronchoscopic diagnostic techniques for diagnosis of VAP.
  
  
  METHODS
  This prospective comparative study was conducted in a medical ICU of a tertiary care center.
  
  
  METHODS
  Twenty-five patients, clinically diagnosed with VAP, were evaluated by bronchoscopic and non-bronchoscopic procedures for diagnosis. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of various bronchoscopic and non-bronchoscopic techniques were calculated, taking clinical pulmonary infection score (CPIS) of ≥6 as reference standard.
  
  
  RESULTS
  Our study has shown that for the diagnosis of VAP, bronchoscopic brush had a sensitivity, specificity, PPV and NPV of 94.9% [confidence interval (CI): 70.6-99.7], 57.1% (CI: 13.4-86.1), 85% (CI: 61.1-96) and 80% (CI: 21.9-98.7), respectively. Bronchoscopic bronchoalveolar lavage (BAL) had a sensitivity, specificity, PPV and NPV of 77.8% (CI: 51.9-92.6), 71.8% (CI: 24.1-94), 87.3% (CI: 60.4-97.8) and 55.5% (CI: 17.4-82.6), respectively. Sensitivity, specificity, PPV and NPV for non-bronchoscopic BAL (NBAL) were 83.3% (CI: 57.7-95.6), 71.43% (CI: 24.1-94), 88.2% (CI: 62.3-97.4) and 62.5% (CI: 20.2-88.2), respectively. Endotracheal aspirate (ETA) yield was only 52% and showed poor concordance with BAL (κ-0.351; P-0.064) and NBAL (k-0.272; P-0.161). There was a good microbiologic concordance among different bronchoscopic and non-bronchoscopic distal airway sampling techniques.
  
  
  CONCLUSIONS
  NBAL is an inexpensive, easy, and useful technique for microbiologic diagnosis of VAP. Our findings, if verified, might simplify the approach for the diagnosis of VAP.
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: G C
authors.initials: GC
authors.lastname: Khilnani
authors.forename: T K Luqman
authors.initials: TK
authors.lastname: Arafath
authors.forename: Vijay
authors.initials: V
authors.lastname: Hadda
authors.forename: Arti
authors.initials: A
authors.lastname: Kapil
authors.forename: Seema
authors.initials: S
authors.lastname: Sood
authors.forename: S K
authors.initials: SK
authors.lastname: Sharma