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Abstract: Poster Presentations |

THE STUDY OF THE EFFICIENCY OF A NEW AND CHEAP AND SAFE METHOD IN ACQUIRING A MINI-BRONCHOALVEOLAR LAVAGE SAMPLE FOR DIAGNOSIS OF VENTILATOR-ASSOCIATED PNEUMONIA: AN INITIAL EGYPTIAN TRIAL FREE TO VIEW

Nevine M. Abd Elfattah, MD*; Ashraf M. Madkour, MD; Samar H. Sharkawy, MD; Gehan Fahmy, MD
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Chest Department Faculty of medicine Ain Shams University, Cairo, Egypt


Chest


Chest. 2009;136(4_MeetingAbstracts):82S-c-83S. doi:10.1378/chest.136.4_MeetingAbstracts.82S-c
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Abstract

PURPOSE:  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.

METHODS:  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.

RESULTS:  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.

CONCLUSION:  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.

CLINICAL IMPLICATIONS:  Cost effective ,non invasive and early VAP diagnostic tool.

DISCLOSURE:  Nevine Abd Elfattah, No Financial Disclosure Information; No Product/Research Disclosure Information

Wednesday, November 4, 2009

12:45 PM - 2:00 PM


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