Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-20T04:46:27.117Z Has data issue: false hasContentIssue false
  • English
  • Français

The Standardization of Bronchoscopic Techniques for Ventilator-Associated Pneumonia

Published online by Cambridge University Press:  21 June 2016

G. Umber-to Meduri  and
Jean Chastre
G. Umber-to Meduri
Affiliation:
Division of Pulmonary and Critical Care Medicine, The University of Tennessee, Memphis
Jean Chastre
Affiliation:
Service de Réanimation Médicale, Hospital Bichat, Paris, France
Get access Rights & Permissions [Opens in a new window]

Extract

During the last decade, several centers have directed their research efforts at defining more efficient modalities for the accurate diagnosis of ventilator-associated pneumonia (VAP). Accurate diagnosis is an essential prerequisite for clinical investigation. Initial studies, which correlated histologic findings and quantitative bacterial cultures of the lung with the findings of protected specimen brush cultures have stimulated clinical investigation of VAF! Two diagnostic techniques, protected specimen brushing (PSB) and bronchoalveolar lavage (BAL), have been extensively investigated and have shown promising results. Advancements in the field, however, have been limited by the lack of standardization, particularly for BAL. In this communication, we attempt to standardize methodology for presently available bronchoscopic techniques and interpretation of data obtained by bronchoscopy to facilitate comparisons among investigations and to promote multicenter collaboration.

Type
Proceedings of the First International Consensus Conference on the Clinical Investigation of Ventilator-Associated Pneumonia
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 11 , November 1992 , pp. 640 - 649
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Guerra, LF, Baughman, RP. Use of bronchoalveolar lavage to diagnose bacterial pneumonia in mechanically ventilated patients. Crit Cure Med. 1990;18:169–173.Google Scholar
2. Trouillet, JL, Guiguet, M, Gibert, C, et al. Fiberoptic bronchoscopy in ventilated patients: evaluation of cardiopulmonary risk under midazolam sedation. Chest. 1990;97:927–933.CrossRefGoogle ScholarPubMed
3. Lindholm, CE, Oilman, B, Snyder, JV, et al. Cardiorespiratory effects of flexible fiberoptic bronchoscopy in critically ill patients. Chest. 1978;74:362–368.Google Scholar
4. Fagon, JY, Chastre, J, Hance, AJ, et al. Detection of nosocomial lung infection in ventilated patients: use of a protected specimen brush and quantitative culture techniques in 147 patients. Am Rev Respir Dis. 1988;138:110–116.CrossRefGoogle ScholarPubMed
5. Torres, A, De La Bellacasa, JP, Rodriguez-Roisin, R, et al. Diagnostic value of telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia using the Metras catheter. Am Rev Respir Dis. 1988;138:117–120.Google Scholar
6. Lambert, RS, Vereen, LE George, RB. Comparison of tracheal aspirates and protected brush catheter specimens for identifying pathogenic bacteria in mechanically ventilated patients. Am ] Med Sci. 1989;297:377–382.Google Scholar
7. Torres, A, Aznar, R, Gatell, JM, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in ventilated patients. Ann Rev Respir Dis. 1990;142:523–528.Google Scholar
8. Standiford, TJ, Kunkel, SL Strieter, RM. Elevated serum levels of tumor necrosis factor-alpha after bronchoscopy and bronchoalveolar lavage. Chest. 1991;99:1529–1530.CrossRefGoogle ScholarPubMed
9. Meduri, GU, Stover, DE, Greeno, R, et al. Bilateral bronchoalveolar lavage in the diagnosis of opportunistic pulmonary infections. Chest. 1991;100:1272–1276.Google Scholar
10. Meduri, GU, Belenchia, JM, Estes, RJ, et al. Fibroproliferative phase of ARDS: clinical findings and effects of corticosteroids. Chest. 1991;100:943–952.CrossRefGoogle ScholarPubMed
11. Johanson, WG Jr, Seidenfeld, JJ, Gomez, P, et al. Bacteriologic diagnosisofnosocomialpneumoniafollowingprolonged mechanical ventilation. Am Rev Respir Dis. 1988;137:259–264.Google Scholar
12. Rouby, JJ, Rossignon, MD, Nicolas, MH, et al. A prospective study of protected bronchoalveolar lavage in the diagnosis of nosocomial pneumonia. Anesthesiology. 1989;71:679–685.Google Scholar
13. Baughman, RP, Thorpe, JE, Staneck, J, et al. Use of the protected specimen brush in patients with endotracheal or tracheostomy tubes. Chest. 1987;91:233–235.Google Scholar
14. Belenchia, JM, Wunderink, RG, Meduri, GU, et al. Alternative causes of fever in ARDS patients suspected of having pneumonia. Am Rev Respir Dis. 1991;A683.Google Scholar
15. Pham, LH, Brun-Buisson, C, Legrand, R et al. Diagnosis of nosocomial pneumonia in mechanically ventilated patients: comparison of a plugged telescoping catheter with the protected specimen brush. Am Rev Respir Dis. 1991;143:1055–1061.CrossRefGoogle ScholarPubMed
16. Pugin, J, Auckenthaler, R, Mili, N, et al. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic blind bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991;143:1121–1129.Google Scholar
17. Fagon, JY, Chastre, J, Domart, Y et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation: prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis. 1989;139:877–884.CrossRefGoogle ScholarPubMed
18. Mauldin, GL, Meduri, GU, Wunderink, RG, et al. Causes of fever and pulmonary infiltrates in mechanically ventilated patients. Am Rev Respir Dis. 1991;143:A109.Google Scholar
19. Bartlett, JG, Alexander, J, Mayhew, J, et al. Should fiberoptic bronchoscopy aspirates be cultured? Am Rev Respir Dis. 1976;114:73–78.Google Scholar
20. Fossieck, BE Jr., Parker, RH, Cohen, MH, et al. Fiberoptic bronchoscopy and culture of bacteria from the lower respiratory tract. Chest. 1977;72:5–9.Google Scholar
21. Wimberley, N, Willey, S, Sullivan, N Bartlett, JG. Antibacterial properties of lidocaine. Chest. 1979;76:37–40.Google Scholar
22. Rankin, JA. Role of bronchoalveolar lavage in the diagnosis of pneumonia. Chest. 1989;95:187S–90S.Google Scholar
23. Kirkpatrick, MB, Bass, JB Jr. Quantitative bacterial cultures of bronchoalveolar lavage fluids and protected brush catheter specimens from normal subjects. Am Rev Respir Dis. 1989;139:546–548.Google Scholar
24. Wimberley, N, Faling, LJ Bartlett, JG. A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture. Am Rev Respir Dis. 1979;119:337–343.Google Scholar
25. Higuchi, JH, Coalson, JJ, Johanson, WG Jr. Bacterial diagnosis of nosocomial pneumonia in primates: usefulness of the protected specimen brush. Am Rev Respir Dis. 1982;125:53–75.Google Scholar
26. Chastre, J, Viau, F, Brun, P, et al. Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated patients. Am Rev Respir Dis. 1984;130:924–929.Google Scholar
27. The BAL Cooperative Group Steering Committee. Bronchoalveolar lavage constituents in healthy individuals, idiopathic pulmonary fibrosis, and selected comparison groups. Am Rev Respir Dis. 1990;141:169–202.Google Scholar
28. Meduri, GU. Baselski, V. The role of bronchoalveolar lavage in diagnosing nonopportunistic bacterial pneumonia. Chest. 1991;100:179–190.CrossRefGoogle ScholarPubMed
29. Kelly, CA, Kotre, CJ, Ward, C, et al. Anatomical distribution of bronchoalveolar lavage fluid as assessed by digital subtraction radiography. Thorax. 1987;42:624–628.Google Scholar
30. Kahn, FW Jones, JM. Diagnosing bacterial respiratory infection by bronchoalveolar lavage. J Infect Dis. 1987;155:862–869.CrossRefGoogle ScholarPubMed
31. Chastre, J, Fagon, JY, Soler, R et al. Diagnosis of nosocomial bacterial pneumonia in intubated patients undergoing ventilation: comparison of the usefulness of bronchoalveolar lavage and the protected specimen brush. Am J Med. 1988;85:499–506.Google Scholar
32. Gaussorgues, R, Piperno, D Bachmann, R. et al. Comparison of nonbronchoscopic bronchoalveolar lavage to open lung biopsy for bacteriologic diagnosis of pulmonary infections in mechanically ventilated patients. Intensive Cure Med. 1989;15:94–98.Google Scholar
33. Chastre, J, Fagon, JY Soler, R. et al. Quantification of BAL cells containing intracellular bacteria rapidly identifies ventilated patients with nosocomial pneumonia. Chest. 1989;95:190S–192S.Google Scholar
34. Meduri, GU, Beals, D, Maijub, G, et al. Protected bronchoalveolar lavage: a new bronchoscopic technique to retrieve uncontaminated distal airway secretions. Am Rev Respir Dis. 1991;143:855–864.Google Scholar
35. Dotson, RG Pingleton, SK. Bronchoalveolar lavage and protected specimen brush cultures in ventilator associated pneumonia. Chest. 1991;100:36S.Google Scholar
36. Thorpe, JE, Baughman, RP, Frame, FT, et al. Bronchoalveolar lavage for diagnosing acute bacterial pneumonia. J Infect Dis. 1987;155:855–861.Google Scholar
37. Torres, A, De La Bellacasa, JR, Xaubet, A, et al. Diagnostic value of quantitative cultures of bronchoalveolar lavage and telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia. Am Rev Respir Dis. 1989;140:306–310.CrossRefGoogle ScholarPubMed
38. Shepherd, K, Lynch, K, Wilson, R, et al. Diagnosis of pneumonia in patients with adult respiratory distress syndrome. Chest. 1988;98(suppl):4S.Google Scholar
39. Bartlett, JG Finegold, SM. Bacteriology of expectorated sputum with quantitative culture and wash technique compared to transtracheal aspirates. Am Rev Respir Dis. 1978;117:1019–1027.Google Scholar
40. Bartlett, JG. Invasive diagnostic techniques in pulmonary infections. In: Pennington, JE, ed. Respiratory Infections: Diagnosis and Management. 2nd ed. New York, NY: Raven Press; 1989:52–68.Google Scholar
41. Marquette, CH, Ramon, R, Courcol, R, et al. Bronchoscopic protected catheter brush for the diagnosis of pulmonary infections. Chest. 1988;93:746–755.Google Scholar
42. De Castro, FR, Violan, JS, Capuz, BL, et al. Reliability of the bronchoscopic protected catheter brush in the diagnosis of pneumonia in mechanically ventilated patients. Crit Cure Med. 1991;19:171–175.Google Scholar
43. Martos, JA, Ferrer, M, Torres, A, et al. Specificity of quantitative cultures of protected specimen brush and bronchoalveolar lavage in mechanically ventilated patients [abstract]. Am Rev Respir Dis. 1990;141:A276.Google Scholar
44. Villers, D, Derriennic, M Rani, E. et al. Reliability of the bronchoscopic protected catheter brush in intubated and ventilated patients. Chest. 1985;88:527–530.Google Scholar
45. El-Ebiary, M, Torres, A, Gonzalez, J, et al. Diagnosis of ventilator-associated (VA) pneumonia: diagnostic value of quantitative cultures of endotracheal aspirates (EA) [abstract]. Am Rev Respir Dis. 1991;143:A108.Google Scholar
46. Middleton, RM, KirkDatrick, MB. Comparison of four methods to assess airway bacteriology in the i&bated mechanically- ventilated patient [abstract]. Am Rev Respir Dis. 1991;143:A107.Google Scholar
47. Baigelman, W, Bellin, S, Cupples, LA, et al. Bacteriologic assess ment of the lower respiratory tract in intubated patients. Crit Cure Med. 1986;14:864–867.Google Scholar
48. Papazian, L, Martin, C, Albanese, J, et al. Comparison of two methods of bacteriologic sampling of the lower respiratory tract: a study in ventilated patients with nosocomial bronchopneumonia. Crit Cure Med. 1989;17:461–464.Google Scholar
49. Zucker, A, Pollack, M Katz, R. Blind use of the double-lumen plugged catheter for diagnosis of respiratory tract infections in critically, ill children. Crit Cure Med. 1984:12:867–870.Google Scholar
50. Joshi, JH, Wang, KP, Dejongh, CA, et al. A comparative evaluation of two fiberoptic bronchoscopy catheters: the plugged telescoping catheter versus the single sheathed nonplugged catheter. Am Rev Resbir Dis. 1982;126:860–863.Google Scholar
51. Hayes, DA McCarthy, LC Friedman, M. Evaluation of two bronchofiberscopic methods of culturing the lower respiratory tract. Am Rev Resbir Dis. 1980:122:319–323.Google ScholarPubMed
52. Glanville, AR, Marlin, GE, Hartnett, BJS, et al. The use of fiberoptic bronchoscopy with sterile catheter in the diagnosis of pneumonia. Aust NZ J Med. 1985;15:309–319.Google Scholar
53. Torzillo, PJ, McWilliam, DB, Young, IH, et al. Use of protected telescoping brush system in the management of bacterial pulmonary infection in intubated patients. BY J Dis Chest. 1985;79:125–131.Google Scholar
54. Reynolds, HY. Bronchoalveolar lavage. Am Rev Respir Dis. 1987;135:250–263.Google Scholar
55. Baughman, RP, Bosken, CH, Loudon, RG, et al. Quantitation of bronchoalveolar lavage with methylene blue. Am Rev Respir Dis. 1983;128:266–270.Google Scholar
56. Rennard, S, Basset, G, Lecossier, D, et al. Estimations of the absolute volume of epithelial lining fluid recovered by bronchoalveolar lavage using urea as an endogenous marker of dilution. J Appl Physiol. 1986;60:532–538.Google Scholar
57. Castella, J, Puzo, C, Ausina, V, et al. Diagnosis of pneumonia with a method of protected bronchoalveolar lavage [abstract]. Eur Respir Jour. 1991;4:407S.Google Scholar