Utility of bilateral bronchoalveolar lavage for the diagnosis of ventilator-associated pneumonia in critically ill surgical patients

Jackson, Sha-Ron; Ernst, Neil E.; Mueller, Eric W.; Butler, Karyn L.

doi:10.1016/j.amjsurg.2007.09.030

« Previous Next »The American Journal of Surgery
Volume 195, Issue 2 , Pages 159-163, February 2008

Utility of bilateral bronchoalveolar lavage for the diagnosis of ventilator-associated pneumonia in critically ill surgical patients

Sha-Ron Jackson, M.D.
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, P.O. Box 670558, Cincinnati, OH 45264, USA
Neil E. Ernst, Pharm.D.
- Division of Pharmacy Practice, University of Cincinnati, 3225 Eden Avenue, 136 Health Professions Building, Cincinnati, OH 45267, USA
- Department of Pharmacy Services, The University Hospital, 234 Goodman Street, Cincinnati, OH 45219, USA
Eric W. Mueller, Pharm.D.
- Division of Pharmacy Practice, University of Cincinnati, 3225 Eden Avenue, 136 Health Professions Building, Cincinnati, OH 45267, USA
- Department of Pharmacy Services, The University Hospital, 234 Goodman Street, Cincinnati, OH 45219, USA
- Corresponding author. Tel.: +1-513-558-8931; fax: +1-513-558-0546.
Karyn L. Butler, M.D.
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, P.O. Box 670558, Cincinnati, OH 45264, USA
- Division of Trauma/Critical Care, University of Cincinnati, 231 Albert Sabin Way, G933, Cincinnati, OH 45267, USA

Received 16 July 2007; received in revised form 20 September 2007 published online 21 December 2007.

Abstract

Background

Bronchoalveolar lavage (BAL) is recommended to facilitate the diagnosis of ventilator-associated pneumonia (VAP). It is unclear if bilateral sampling improves the accuracy of BAL.

Methods

Consecutive patients with clinical suspicion for VAP were analyzed. All patients underwent bilateral BAL. A threshold of >10⁴ colony-forming units (cfu)/mL was diagnostic for VAP (VAP positive). Samples were concordant if the organism(s) and thresholds from both lungs were diagnostically consistent. Organisms ≤10⁴ cfu/mL with growth on the contralateral sample >10⁴ cfu/mL were considered false-negative samples.

Results

Between November 2005 and April 2006, 73 patients were considered clinically suspicious for VAP. Forty-four (60%) patients were VAP positive. Twenty-eight (64%) VAP patients had concordant samples. Overall, there were 15 false-negative samples. Sole use of the unilateral samples to guide treatment would have inappropriately directed antibiotic avoidance and/or discontinuation in 25% of VAP patients. Influence of the chest radiograph was equivocal because of the presence of bilateral infiltrates in 80% of discordant samples.

Conclusions

Bilateral BAL improves the accuracy of bronchoscopy in diagnosing VAP. Unilateral BAL may be insensitive in patients with clinically significant contralateral infection.

Keywords: Bronchoalveolar lavage, Bronchoscopy, Critical illness, Surgery