As physicians in a developing country cost effectiveness is an important consideration. Previously the diagnosis of VAP was performed using expensive procedures, this lead us to develop a cheap, available and safe method of Mini Bronchoalveolar lavage (BAL) sampling. Our new method was studied in comparison with classical BAL and Endotracheal Aspirate (ETA) sampling.
Prospective clinical study performed at the respiratory Critical care unit . 40 patients (mean age 48.77 ± 12.59) with suspected VAP according to the American Thoracic Society (ATS) guidelines 2005, underwent sampling through our new mini-BAL method, bronchoscopic BAL and ETA to confirm diagnosis. A nelaton catheter size 18 FG was used as the outer protective catheter , an infant ryle catheter (30) was used as the inner one , the outer catheter was blocked by sterile K-Ygel instead of the red polyethelene protective red plug in the original Combicath catheter. All samples where studied bacteriologically quantitatively and qualitatively. Results where further correlated and statistically analyzed.
Out of the 40 suspected patients 35 where diagnosed by BAL and mini- BAL to be suffering from VAP. Using the Kappa test there was perfect agreement between BAL and min-BAL as regards the diagnosis of VAP , on the contrary the ETA showed no agreement . Maximum positive correlation(1) was reported amidst the BAL and the mini BAL, which was also highly significant (p = 0). In addition the mini-BAL sensitivity and specificity was 100% while the ETA revealed a sensitivity of 100% but a specificity of 0%. The new method did not record any complications or morbidity. The cost of the new mini-BAL method was 3 $while the classical BAL cost was 70$ per patient.
The new sampling method proved to be highly effective sensitive and as specific as the classical BAL. However it has the advantage in being much cheaper , non invasive and does not require the expertise for preforming bronchoscopic sampling.
Cost effective ,non invasive and early VAP diagnostic tool.
Nevine Abd Elfattah, No Financial Disclosure Information; No Product/Research Disclosure Information