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Correspondence |

Promises and Limitations of the Bronchoscopic Microsampling Probe FREE TO VIEW

Eric Kipnis, MD; Benoit Guery, PhD; Jeanine Wiener-Kronish, MD, FCCP
Author and Funding Information

Affiliations: Centre Hospitalier Régional Universitaire de Lille, Lille, France,  University of California San Francisco, San Francisco, CA

Correspondence to: Eric Kipnis, MD, Centre Hospitalier Universitaire Régional de Lille, Réanimation Chirurgicale, Hôpital Claude Huriez, rue Michel Polonowski, Lille Nord 59037, France; e-mail: ekipnis@gmail.com



Chest. 2007;132(4):1414. doi:10.1378/chest.07-0519
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To the Editor:

We read with interest the study by Sasabayashi et al in CHEST (February 2007)1demonstrating the capacity of the bronchoscopic microsampling (BMS) probe to recover bacteria from suspensions. We agree that the BMS probe may be a promising tool for bacterial sampling compared to the actual standard BAL. Indeed, the variability of bacterial recovery by BAL is a major problem that has been underlined by a 2005 study2showing that, after correction of the dilution of epithelial lining fluid by BAL, the bacterial count could vary up to 130-fold! However, although we ourselves believe in applications of the BMS probe such as the direct recovery of epithelial lining fluid for proteomic analysis, which we achieved with success,3and although it has also been deemed promising in a recent review in CHEST,4 the BMS probe presents limitations that the authors fail to discuss.

While a bacterial recovery procedure using the BMS probe is less invasive than BAL, it still requires bronchoscopy and is not as uninvasive as blind techniques such as mini-BAL or protected-specimen brush. We have developed such a method in an animal study3 with the BMS probe inserted blindly through a catheter (Combicath; KOL Bio Medical Instruments; Chantilly, VA) that is routinely used for performing mini-BAL, although it has yet to be confirmed in a clinical setting. Furthermore, although the use of bronchoscopy may be an advantage in guiding the BMS probe toward an infected lung segment, it limits the widespread use of the probe compared to simple diagnostic methods such as quantitative cultures of endotracheal aspirates. Additionally, with the BMS probe it is impossible to explore great portions of the lung. Lung diseases such as pneumonia or ARDS are far from homogeneous, and the use of the BMS probe for diagnosis could lead to the failure of specimen recovery just as the BMS probe failed to recover detectable amounts of a lung inflammation marker (procollagen type III peptide) in ARDS patients.5 Further studies will define the clinical usefulness of the BMS probe.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Sasabayashi, M, Yamazaki, Y, Tsushima, K, et al (2007) Usefulness of bronchoscopic microsampling to detect the pathogenic bacteria of respiratory infection.Chest131,474-479. [PubMed] [CrossRef]
 
Zedtwitz-Liebenstein, K, Schenk, P, Apfalter, P, et al Ventilator-associated pneumonia: increased bacterial counts in bronchoalveolar lavage by using urea as an endogenous marker of dilution.Crit Care Med2005;33,756-759. [PubMed]
 
Kipnis, E Using urea as an endogenous marker of bronchoalveolar lavage dilution [letter].Crit Care Med2005;33,2153. [PubMed]
 
Bowler, RP, Ellison, MC, Reisdorph, N Proteomics in pulmonary medicine.Chest2006;130,567-574. [PubMed]
 
Ishizaka, A, Watanabe, M, Yamashita, T, et al New bronchoscopic microsample probe to measure the biochemical constituents in epithelial lining fluid of patients with acute respiratory distress syndrome.Crit Care Med2001;29,896-898. [PubMed]
 

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References

Sasabayashi, M, Yamazaki, Y, Tsushima, K, et al (2007) Usefulness of bronchoscopic microsampling to detect the pathogenic bacteria of respiratory infection.Chest131,474-479. [PubMed] [CrossRef]
 
Zedtwitz-Liebenstein, K, Schenk, P, Apfalter, P, et al Ventilator-associated pneumonia: increased bacterial counts in bronchoalveolar lavage by using urea as an endogenous marker of dilution.Crit Care Med2005;33,756-759. [PubMed]
 
Kipnis, E Using urea as an endogenous marker of bronchoalveolar lavage dilution [letter].Crit Care Med2005;33,2153. [PubMed]
 
Bowler, RP, Ellison, MC, Reisdorph, N Proteomics in pulmonary medicine.Chest2006;130,567-574. [PubMed]
 
Ishizaka, A, Watanabe, M, Yamashita, T, et al New bronchoscopic microsample probe to measure the biochemical constituents in epithelial lining fluid of patients with acute respiratory distress syndrome.Crit Care Med2001;29,896-898. [PubMed]
 
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