Quantitative tracheal lavage versus bronchoscopic protected specimen brush for the diagnosis of nosocomial pneumonia in mechanically ventilated patients |
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Authors: | Aucar John A Bongera Miguel Phillips Jeffrey O Kamath Ravishankar Metzler Michael H |
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Affiliation: | a Division of General Surgery, Trauma and Critical Care, Department of Surgery, University of Missouri-Columbia, MC 418, One Hospital Dr., Columbia, MO 65212, USA |
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Abstract: | BackgroundNo gold standard method exists for the diagnosis of ventilator-associated pneumonia despite the availability of multiple techniques.MethodsA prospective, crossover study was performed on mechanically ventilated patients meeting with suspected pneumonia. Eighteen paired samples were obtained on 15 patients, comparing the results of quantitative tracheal lavage (QTL) to bronchoscopic protected brush specimen (PSB) by quantitative culture and gram stain examination.ResultsThe sensitivity, specificity, positive and negative predictive values, and accuracy are affected by the growth density threshold selected, and whether the same organisms are expected by both methods. There is a significant relationship between QTL and PSB (P = 0.0048; R = 0.632), gram stain and PSB (P <0.001; R = 0.791), and gram stain and QTL (P = 0.0125; R = 0.575), by Spearman rank order correlation.ConclusionsQTL may have a role for diagnosing and directing treatment of ventilator-associated pneumonia, allowing reservation of bronchoscopic PSB for secondary, high risk and refractory cases. |
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Keywords: | Pneumonia Diagnosis Mechanical ventilation Tracheal lavage |
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