[Bronchoalveolar lavage for diagnosing pneumonia in mechanically ventilated patients]. / Lavado broncoalveolar para el diagnóstico de neumonía en enfermos en ventilación mecánica.

OBJECTIVE: To evaluate the diagnostic role of bronchoalveolar lavage (BAL) in mechanically ventilated patients with suspected pneumonia and to describe the clinical outcome in the different kinds of pneumonia in critically ill patients. DESIGN: Descriptive study. SETTING: A 17-bed medical and surgical intensive care unit. PATIENTS: Mechanically ventilated patients admitted to the ICU from November 2003 to March 2006 with suspected pneumonia who underwent bronchoscopy with BAL. INTERVENTIONS: BAL was performed by fiberoptic bronchoscopy with three aliquots of 50 ml sterile normal saline. Recovered BAL fluid was pro-cessed for microbiologic analysis. MAIN VARIABLES OF INTEREST: Age, APACHE II score within the first 24 hours of admission, time on mechanical ventilation, ICU length of stay, mortality, and isolated bacteria were analyzed. RESULTS: A total of 96 cases of suspected pneumonia with BAL were recruited, including 4 groups: community associated pneumonia (CAP), 12 cases, early-onset ventilator-associated pneumonia (VAP), 26 cases, late-onset ventilator-associated pneumonia, 43 cases, and immunocompromised patients, 15 cases. BAL was positive (> 10000 ufc/ml) in 40 (41.7%) patients (2, 16, 17 and 5 patients with CAP, early-onset VAP, late-onset VAP and immunocompromised, respectively). Mortality was 33.3%, 26.9%, 25.6% and 73.3% in CAP, early-onset VAP, late-onset VAP and immunocompromised patients respectively. CONCLUSIONS: The low incidence of positive BAL in the CAP group supports using BAL only for particularly severe, selected cases. Mortality was very high in the immunocompromised patients. In the light of our personal experience, BAL is most useful in the diagnosis of pneumonia in the group of patients with VAP.

Lavado broncoalveolar para el diagnóstico de neumonía en enfermos en ventilación mecánica / C-reactive protein as a marker of mortality in intensive care unit

Objetivo. Evaluar la utilidad diagnóstica del lavado broncoalveolar (LBA) en enfermos en ventilación mecánica con sospecha de neumonía y describir los resultados clínicos de los diferentes tipos de neumonía en enfermos críticos. Diseño. Estudio descriptivo. Ámbito. Unidad de cuidados intensivos (UCI) médico-quirúrgica de 17 camas. Pacientes. Enfermos ingresados en UCI desde noviembre de 2003 a marzo de 2006 con ventilación mecánica y sospecha clínica de neumonía a quienes se realizó LBA. Intervenciones. Se realizó LBA a través de tubo orotraqueal con 150 ml de suero salino fisiológico, repartidos en tres alícuotas de 50 ml; la muestra se procesó para estudio microbiológico. Principales variables de interés. Edad, APACHE II al ingreso, días en ventilación mecánica, estancia en UCI, mortalidad y agentes etiológicos aislados en el LBA. Resultados. Se incluyó a 96 pacientes a quienes se realizó LBA; se distinguieron 4 grupos: neumonía adquirida en la comunidad (NAC), 12 casos; neumonía asociada a ventilación mecánica (NAVM) precoz, 26 casos. NAVM tardía, 43 casos, y neumonía en enfermos inmunodeficientes, 15 casos. El LBA fue positivo (> 10.000 ufc/ml) en 40 (41,7%) pacientes (2 con NAC, 16 con NAVM precoz, 17 con NAVM tardía, 5 con neumonía e inmunodeficiencia). La mortalidad fue del 33,3, el 26,9, el 25,6 y el 73,3% en NAC, NAVM precoz, NAVM tardía e inmunodeficientes, respectivamente. Conclusiones. La escasa sensibilidad del LBA en la NAC corrobora la actitud de limitar su indicación sólo a casos seleccionados. En el grupo de enfermos inmunodeficientes la mortalidad fue muy elevada. El LBA, según nuestra limitada experiencia, tiene su mayor utilidad en el diagnóstico de NAVM

Objective. To evaluate the diagnostic role ofbronchoalveolar lavage (BAL) in mechanicallyventilated patients with suspected pneumoniaand to describe the clinical outcome in the differentkinds of pneumonia in critically ill patients.Design. Descriptive study.Setting. A 17-bed medical and surgical intensivecare unit.Patients. Mechanically ventilated patients admittedto the ICU from November 2003 to March2006 with suspected pneumonia who underwentbronchoscopy with BAL.Interventions. BAL was performed by fiberopticbronchoscopy with three aliquots of 50 ml sterilenormal saline. Recovered BAL fluid was processedfor microbiologic analysis.Main variables of interest. Age, APACHE IIscore within the first 24 hours of admission, timeon mechanical ventilation, ICU length of stay,mortality, and isolated bacteria were analyzed.Results. A total of 96 cases of suspected pneumoniawith BAL were recruited, including 4 groups: community associated pneumonia (CAP), 12 cases, early-onset ventilator-associated pneumonia (VAP), 26 cases, late-onset ventilator-associated pneumonia, 43 cases, and immunocompromised patients, 15 cases. BAL was positive (>10000 ufc/ml) in 40 (41.7%) patients (2, 16, 17 and5 patients with CAP, early-onset VAP, late-onset VAP and immunocompromised, respectively).Mortality was 33.3%, 26.9%, 25.6% and 73.3% inCAP, early-onset VAP, late-onset VAP and immunocompromised patients respectively.Conclusions. The low incidence of positive BALin the CAP group supports using BAL only for particularlysevere, selected cases. Mortality wasvery high in the immunocompromised patients. Inthe light of our personal experience, BAL is mostuseful in the diagnosis of pneumonia in the groupof patients with VAP