PURPOSE: Our objective was to compare the results of a blind lavage vs. a bronchoscopic-guided bronchoalveolar lavage for the etiologic diagnosis of ventilator associated pneumonia.
METHODS: Prospective study involving 25 consecutive adult patients with high probability of ventilator associated pneumonia. Every patient underwent a blind bronchoalveolar lavage with a modified nasogastric tube, and a bronchospic-guided bronchoalveolar lavage. The study was done in a formally randomized fashion to determine the order of the procedures. The interpretation of quantitative cultures was done by blinded expert microbiologists. This is a single center study, in a 20 bed medical and surgical intensive care unit of the University Hospital in Monterrey, Mexico.
RESULTS: Twenty-one patients underwent both procedures. Four patients were excluded due to contamination of the cultures. The quantitative cultures were compared in a paired fashion. Only 2 patients had discordant cultures. The correlation coefficient between the number of colonies was very high r=0.90 (95% CI, 0.77–0.96 p=0.0001).
CONCLUSION: The blind bronchoalveolar lavage with a modified nasogastric tube is a valuable tool for the identification of etiologic agent in VAP, particularly when trained bronchoscopists or the necessary resources for bronchoscopic-guided bronchoalveolar lavage are not readily available.
CLINICAL IMPLICATIONS: In this single center, prospective study we demonstrated the excellent operating characteristics of a non-bronchoscopic bronchoalveolar lavage technique using a nasogastric tube compared with the frequently cited fiberoptic bronchoscope-guided BAL. The results of our study have important implications in the care of patients with VAP in resource-constrained settings, where the availability of bronchoscopes to confirm the diagnosis of VAP is limited.We believe this innovative and simple technique should be validated in larger clinical trials, where antibiotic use, organ dysfunction improvement, and ultimately survival should be used as outcome measures.
DISCLOSURE: Erik Folch, No Financial Disclosure Information; No Product/Research Disclosure Information