title: Diagnosis of bacterial ventilator-associated pneumonia in children: reproducibility of blind bronchial sampling.
abstract: OBJECTIVE
  To evaluate the reproducibility of blind bronchial sampling in patients with suspected diagnosis of bacterial ventilator-associated pneumonia.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Pediatric intensive care unit of a tertiary care, multidisciplinary, teaching hospital in Northern India.
  
  
  METHODS
  All consecutive patients on mechanical ventilation for >48 hrs were evaluated clinically for ventilator-associated pneumonia.
  
  
  METHODS
  Children with clinical ventilator-associated pneumonia were subjected to blind bronchial sampling twice.
  
  
  RESULTS
  Sixty-eight blind bronchial sampling samples from 34 patients were analyzed for polymorphonuclear cells, the presence, type, and number of bacteria. Acinetobacter baumannii was the most common organism grown from distal respiratory secretions. For polymorphonuclear cells, the concordance between two blind bronchial samples was 85.3% and kappa coefficient was 0.65. The concordance for the presence and type of bacteria in Gram staining in two samples was 85.3% and kappa coefficient was 0.68. The intraclass coefficients for bacterial index and predominant species index were 0.82 (95% confidence interval 0.65-0.91) and 0.89 (95% confidence interval 0.78-0.94), respectively. The use of prior antibiotics did not adversely affect the reproducibility of blind bronchial sampling. No major complications were recorded during the procedure.
  
  
  CONCLUSIONS
  Blind bronchial sampling of lower respiratory tract secretions in mechanically ventilated patients generates reproducible results of quantitative and qualitative cultures. We suggest that blind bronchial sampling may provide valuable clue to the bacterial etiology in ventilated child with suspected clinical ventilator-associated pneumonia.
authors.affiliation: Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Sachdev
authors.forename: Krishan
authors.initials: K
authors.lastname: Chugh
authors.forename: Veena
authors.initials: V
authors.lastname: Raghunathan
authors.forename: Dhiren
authors.initials: D
authors.lastname: Gupta
authors.forename: Chand
authors.initials: C
authors.lastname: Wattal
authors.forename: Geetha R
authors.initials: GR
authors.lastname: Menon
mesh_terms: D000151:Acinetobacter Infections / Q000150:complications / Q000175:diagnosis*; D040981:Acinetobacter baumannii; D000293:Adolescent; D001980:Bronchi / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009504:Neutrophils; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000382:microbiology; D011552:Pseudomonas Infections / Q000150:complications / Q000175:diagnosis*; D011550:Pseudomonas aeruginosa; D015203:Reproducibility of Results; D013048:Specimen Handling / Q000009:adverse effects / Q000379:methods*; D013396:Suction