Impact of BAL on the diagnosis and treatment of nosocomial pneumonia in ICU patients


Nosocomial pneumonia and ventilator-associated pneumonia are currently the second leading cause of nosocomial infections and account for approximately 10-15% of all hospital-acquired infections. Crude mortality rates range from 24% to 76% depending on the population and clinical setting studied. During the last ten years, several diagnostic methods have been developed to microbiologically confirm the clinical diagnosis, especially in mechanically ventilated patients. This article seeks to clarify the issues surrounding the use of invasive fiberoptic bronchoscopic techniques in the diagnosis and treatment of nosocomial pneumonia.

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    ABSTRACT: To determine the value and safety of fiberoptic bronchoscopy in neonatal and pediatric intensive care units (NICUs, PICUs). A total of 53 fiberoptic bronchoscopy procedures on 47 patients were reviewed. Bronchoalveolar lavage (BAL) was performed in 23 patients. The primary diseases were pneumonia (n = 16), foreign body aspiration (n = 14), congenital airway abnormality (n = 12), trauma and/or following operations (n = 4) and Guillain-Barré syndrome (n = 1). The major bronchoscopic findings included inflammation in 26 patients, foreign body in 14, congenital airway abnormality in 12 and blood clotting in 3. Microbiology on BAL fluid was positive in 19 of 23 patients. In 23 patients with atelectasis, full and partial re-expansion was obtained in 14 and 6 patients, respectively, at 24 h after the procedures. The clinical features of 9 patients with sputum retention or blood clotting improved significantly after BAL. Positive or negative microbiologic BAL fluid results changed treatment in 11 patients, leading to marked clinical improvement in 9 patients. Moreover, 13 patients were extubated within 24 h of bronchoscopy. These data show that fiberoptic bronchoscopy is safe and effective in the diagnosis and therapy of pulmonary disorders in NICUs and PICUs.
    No preview · Article · Feb 2009 · Medical Principles and Practice
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    ABSTRACT: Flexible bronchoscopy has become an important diagnostic and therapeutic tool for the management of patients with various diseases of the chest. Availability of a 24-hour bronchoscopy service equipped with experienced personnel is becoming increasingly important especially for intensive care patients. However, such services have been implemented only in a few medical centres. The aim of this study was to evaluate the usage of a 24-hour emergency service in a large university hospital with a 1 year prospective analysis of emergency bronchoscopy service in a tertiary care centre. Frequencies, indications and efficiency of therapeutic interventions were evaluated after each bronchoscopy using a specially designed questionnaire. All bronchoscopies were performed as emergency procedures out of operational schedule. A total of 614 emergency bronchoscopies were performed, 88% of them in intensive care units. The vast majority (84.5%) of the procedures were necessary for therapeutic interventions; that is, atelectasis, airway secretion, aspiration or bronchopulmonary bleeding. According to prespecified criteria, 37.6% (n = 195) of therapeutic procedures were assessed as 'very helpful' and 3.9% (n = 20) as 'life saving'. Diagnostic bronchoscopies were performed mainly to collect airway material for microbiological evaluations in immunocompromised patients. In these cases, the diagnostic yield was approximately 50%. The availability of a 24-hour bronchoscopy service has been found to improve patient care and was occasionally considered life saving. Thus, comparable services should be made more widely available.
    No preview · Article · Jun 2009 · Therapeutic Advances in Respiratory Disease
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