title: Evaluation of blind nasotracheal suctioning and non-bronchoscopic mini-bronchoalveolar lavage in critically ill patients with infectious pneumonia: a preliminary study.
abstract: BACKGROUND
  We evaluated the diagnostic performance and safety of combined blind nasotracheal suctioning and non-bronchoscopic mini-bronchoalveolar lavage (mini-BAL) to obtain respiratory secretion specimens from spontaneously breathing, non-intubated patients with infectious pneumonia in intensive care.
  
  
  METHODS
  Patients suspected of having infectious pneumonia were included prospectively. Three samples were obtained: expectorated sputum, nasotracheal suctioning, and mini-BAL via a double telescopic catheter (Combicath). Under local anesthesia, nasotracheal suctioning was done according to standard recommendations. Then mini-BAL was performed; the bronchial catheter serves as a guide for the mini-BAL catheter, and tracheal position is verified via colorimetric capnography.
  
  
  RESULTS
  We included 36 subjects (29 men, median age 69 y, median Simplified Acute Physiology Score II 32), of which 32 (89%) underwent nasotracheal suctioning and mini-BAL, and from 13 (36%) we collected expectorated sputum. Based on colorimetric capnography confirmation of the tracheal position, 75% (24/32) of the successful combined procedures were achieved on the first attempt. The median duration of the combined procedure was 7 min. Bacterial pneumonia was diagnosed in 24/36 (67%) subjects, among whom 21 (88%) had undergone successful nasotracheal suctioning and mini-BAL, respectively, for 8/21 (38% [95% CI 0.17-0.58%] and 14/21 (67% [95% CI 0.46-0.86%]). Mini-BAL diagnosed a significantly higher percentage of bacterial pneumonias than did nasotracheal suctioning. Expectorated sputum yielded no diagnoses.
  
  
  CONCLUSIONS
  Blind nasotracheal suctioning confirmed via colorimetric capnography allows microbiological diagnosis, and can be enhanced by non-bronchoscopic mini-BAL. Colorimetric capnography helps confirm bronchial tube position. Non-bronchoscopic mini-BAL is a novel and feasible way to collect bronchial secretions without fibroscopy. (ClinicalTrials.gov NCT00763620.).
authors.affiliation: Intensive Care Unit, Centre Hospitalier Sud Francilien, Corbeil Essonnes, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Meyer
authors.forename: Hélène
authors.initials: H
authors.lastname: Rousseau
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Maillet
authors.forename: Stéphane
authors.initials: S
authors.lastname: Thierry
authors.forename: Oumar
authors.initials: O
authors.lastname: Sy
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Fabrice
authors.initials: F
authors.lastname: Thiolliere
authors.forename: Gerald
authors.initials: G
authors.lastname: Choukroun
authors.forename: Karim
authors.initials: K
authors.lastname: Chergui
authors.forename: Guillaume
authors.initials: G
authors.lastname: Chevrel
authors.forename: Eric
authors.initials: E
authors.lastname: Maury
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018893:Bronchoalveolar Lavage / Q000295:instrumentation / Q000379:methods*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000382:microbiology; D011446:Prospective Studies; D013396:Suction / Q000295:instrumentation / Q000379:methods
keywords: blind nasotracheal suctioning; colorimetric capnography; expectorated sputum; intensive care; mini-bronchoalveolar lavage; pneumonia