PURPOSE: The diagnosis of Ventilator associated pneumonia requires a sample of lower respiratory tract and in a third world country due to non availability of either a bronchoscope and or the specialized catheter, there is considerable delay in starting appropriate antibiotic with high morbidity and mortality.
METHODS: All patient with suspected VAP who met 3 out of 4 diagnostic criteria: 1) Fever 2) Leukocytosis 3) New or worsening infiltrate in Chest radiograph 4) Purulent secretions. Were considered for B-BAL as per the current recommendation and institutional policy. All these patients also had a simultaneous N-BAL done and both the samples were appropriately labeled and submitted for gram stain and quantitative cultures. N-BAL were performed, immediately before the B-BAL by a training fellow. A simple Nasogastric tube size 16 fr was used without any lubrication via the endotracheal tube connector similar to the bronchoscopic method, NG tube was advanced until a resistance was met, using a catheter tip syringe 60 cc of normal saline was injected and than manually aspirated within the syringe.
RESULTS: 30 patients under went paired B-BAL and N-BAL sampling and there was 83.3% qualitative agreement between the sample with a p value of <0.01.The out come was measured in terms of similarity and difference in type of organism isolated through both procedures.
CONCLUSION: The results of our study favors the use of plain Nasogastric tube quantitative cultures in the absence of bronchoscope or specialized catheter This may prove to be a simple, cost-effective, and minimally invasive method of diagnosing VAP.
CLINICAL IMPLICATIONS: In a devolping country where bronchoscopy is very expensive plain N/G lavage can be done in place of bronchoscopy in patient with suspected ventilator associated pneumoniaand can provide valuable information which can used to provide adequate therapy.
DISCLOSURE: Safdar Khan, None.