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Diagnosis of Ventilator-Associated Pneumonia: Focus on Nonbronchoscopic Techniques (Nonbronchoscopic Bronchoalveolar Lavage, Including Mini-BAL, Blinded Protected Specimen Brush, and Blinded Bronchial Sampling) and Endotracheal Aspirates

Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA

Victor L. Yu, MD

Division of Infectious Diseases, VA Medical Center and University of Pittsburgh, University Drive C, Pittsburgh, PA 15240; vly+{at}pitt.edu

The ideal diagnostic approach for ventilator-associated pneumonia currently is based on invasive procedures to obtain respiratory tract cultures. Given the lack of consensus and relatively poor acceptance of full bronchoscopic bronchoalveolar lavage (BAL) and protected specimen brush (PSB), less invasive procedures have been developed. We review the nonbronchoscopic procedures (nonbronchoscopic bronchoalveolar lavage, including mini-BAL, blinded protected specimen, and blinded bronchial sampling) and endotracheal aspiration. We provide a critique of the methods used, the types of catheters inserted, and the sample collection methods. Most studies were flawed in that antibiotic use before initiation of the procedure was not controlled. The variability of both the methods and the criteria for the gold standard in the numerous investigations show that these procedures are neither standardized nor proven to be accurate and often did not improve management. Pending future studies, use of endotracheal aspirates without the use of quantitation seems to be a reasonable approach for clinicians who are not committed to an invasive procedure.

Key Words: ventilator-associated pneumonia • nonbronchoscopic bronchoalveolar lavage • mini-BAL • blinded protected specimen brush • blinded bronchial sampling • endotracheal aspirates

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Journal of Intensive Care Medicine, Vol. 21, No. 1, 17-21 (2006)
DOI: 10.1177/0885066605283094


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Fujitani, S. Articles by Yu, V. L. Search for Related Content PubMed PubMed Citation Articles by Fujitani, S. Articles by Yu, V. L. Pubmed/NCBI databases Medline Plus Health Information Pneumonia Social Bookmarking                         What's this?