Background:The diagnosis of ventilator-associated pneumonia (VAP) remains a challenge, with clinicians mainly relying on clinical, radiological, and bacteriologic strategies to manage patients with VAP.
Aims: Illustrates value of Bronchoalveolar lavage in diagnosis of Patients with Ventilator Associated Pneumonia
Settings and Design: This was a single-center prospective diagnostic accuracy study done in the 22-bedded intensive care unit of Benha university hospital.
Materials and Methods: Patients aged ≥18 years, on mechanical ventilation for ≥48 h, and with clinical suspicion of VAP (fever, leukocytosis, and increased tracheal secretions) and chest x-ray infiltrates .Every patient underwent first non-bronchoscopic protected bronchoalveolar lavage (NP-BAL) and then bronchoscopic BAL (B-BAL) for sample collection. Clinical Pulmonary Infection Score (CPIS) was calculated for each patient and the collected samples were evaluated in laboratory using standard microbiological techniques.
Statistical Analysis Used: The sensitivity, specificity, positive predictive value, and negative predictive value of NP-BAL and B-BAL for the diagnosis of VAP were calculated taking CPIS score of >6 as index test for the diagnosis of VAP.
Results: forty patients were included in the study. Both NP-BAL and B-BAL had concordance with the CPIS at 92.2%. The concordance between NP-BAL and B-BAL was better at 97,36% with a kappa coefficient of 0.89% (P = −0.001). The yield and sensitivity of NP-BAL were comparable to that of B-BAL.
Conclusions: The blind NP-BAL is an equally effective method of airway sampling and could be a better alternative to replace more invasive B-BAL for microbiologic diagnosis of VAP.