A Comparison of Bronchoscopic vs Blind Protected Specimen Brush Sampling in Patients With Suspected Ventilator-Associated Pneumonia

¹ From the Departments of Medicine and Pathology, Detroit Medical Center and Wayne State University School or Medicine, Detroit

Background: Pneumonia is a common complication in patients undergoing mechanical ventilation and increases ICU mortality. The clinical diagnosis of ventilator-associated, however, pneumonia is unreliable, and many consider bronchoscopic-directed protected specimen brush sampling and quantitative culture the diagnostic method of choice. Bronchoscopy, however, is expensive and not readily available in many ICUs.

Objective: To test the hypothesis that "blind" protected specimen brush (PSB) sampling may produce results similar to that of bronchoscopic-directed sampling.

Setting: The medical ICU of a university-affiliated teaching hospital.

Intervention: Patients with suspected ventilator-associated pneumonia (VAP) who had not received antibiotics for at least 48 h underwent "blind" and bronchoscopic-directed PSB sampling with quantitative culture.

Results: Fifty-five paired PSB specimens were obtained from 53 patients. There was an 85% quantitative agreement between the blind and bronchoscopic-directed specimens. The agreement was independent of the bronchopulmonary segment from which the bronchoscopic sampling was directed.

Conclusion: The results of this study are consistent with the notion that blind PSB sampling and quantitative culture may prove to be a useful, cost-effective, and minimally invasive method of diagnosing VAP.

Key Words: blind protected specimen brush • bronchoscopy • ventilator-associated pneumonia

Submitted on October 25, 1994
Accepted on December 8, 2007

This article has been cited by other articles:

				S. M. Koenig and J. D. Truwit Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention Clin. Microbiol. Rev., October 1, 2006; 19(4): 637 - 657. [Abstract] [Full Text] [PDF]

				S. Fujitani and V. L. Yu 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. J Intensive Care Med, January 1, 2006; 21(1): 17 - 21. [Abstract] [PDF]

				J. Chastre and J.-Y. Fagon Ventilator-associated Pneumonia Am. J. Respir. Crit. Care Med., April 1, 2002; 165(7): 867 - 903. [Abstract] [Full Text] [PDF]

				J Dakin and M Griffiths The pulmonary physician in critical care 1: Pulmonary investigations for acute respiratory failure Thorax, January 1, 2002; 57(1): 79 - 85. [Abstract] [Full Text] [PDF]

				P. E. Marik and J. Varon Ventilator-Associated Pneumonia : Science and Hocus-Pocus Chest, September 1, 2001; 120(3): 702 - 704. [Full Text] [PDF]

				P. E. Marik Aspiration Pneumonitis and Aspiration Pneumonia N. Engl. J. Med., March 1, 2001; 344(9): 665 - 671. [Full Text] [PDF]

				R. S. Morehead and S. J. Pinto Ventilator-Associated Pneumonia Arch Intern Med, July 10, 2000; 160(13): 1926 - 1936. [Abstract] [Full Text] [PDF]

				M. S. Niederman Bronchoscopy in Nonresolving Nosocomial Pneumonia Chest, April 1, 2000; 117(4_suppl_2): 212S - 218S. [Full Text] [PDF]

				P. E. Marik Fever in the ICU Chest, March 1, 2000; 117(3): 855 - 869. [Abstract] [Full Text] [PDF]

				M. Casetta, F. Blot, S. Antoun, B. Leclercq, C. Tancrede, F. Doyon, and G. Nitenberg Diagnosis of Nosocomial Pneumonia in Cancer Patients Undergoing Mechanical Ventilation: A Prospective Comparison of the Plugged Telescoping Catheter With the Protected Specimen Brush Chest, June 1, 1999; 115(6): 1641 - 1645. [Abstract] [Full Text] [PDF]

				P. E. Marik and P. Careau The Role of Anaerobes in Patients With Ventilator-associated Pneumonia and Aspiration Pneumonia: A Prospective Study Chest, January 1, 1999; 115(1): 178 - 183. [Abstract] [Full Text] [PDF]