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(Chest. 2002;122:985-989.)
© 2002 American College of Chest Physicians

Role of Transbronchial Needle Aspiration in Patients Receiving Mechanical Ventilation*

Shekhar Ghamande, MD; Albert Rafanan, MD; Raed Dweik, MD, FCCP; Alejandro C. Arroliga, MD, FCCP and Atul C. Mehta, MBBS, FCCP

* From the Department of Pulmonary and Critical Care (Drs. Ghamande, Dweik, Arroliga, and Mehta), Cleveland Clinic Foundation, Cleveland, OH; and Department of Pulmonary and Critical Care Medicine (Dr. Rafanan), St. Vincent Mercy Medical Center Hospital, Medical College of Ohio at Toledo, Toledo, OH.

Correspondence to: Atul C. Mehta, MBBS, FCCP, A90/Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195

Study objectives: To evaluate the diagnostic accuracy and safety of transbronchial needle aspiration (TBNA) in patients receiving mechanical ventilation in the ICU.

Methods: Retrospective review of all patients in the medical and surgical ICUs from February 1999 to July 2001 who underwent TBNA while receiving mechanical ventilation.

Results: A total of eight histology (19 gauge) and eight cytology (22 gauge) TBNAs were performed on eight patients (four men and four women). TBNA yielded a definitive pathologic diagnosis in five of eight patients (62.5%). Diagnoses were posttransplantation lymphoproliferative disorder, large cell carcinoma, poorly differentiated non-small cell carcinoma, squamous cell carcinoma, and adenocarcinoma. Among patients with negative TBNA results (n = 3), two patients underwent mediastinoscopy. Results of mediastinoscopy were non-small cell carcinoma and inflamed tissue. TBNA led to management changes in five of these patients. Excluding one patient in whom a negative TBNA result could not be further confirmed, TBNA yielded a sensitivity of 83%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 50%. The overall accuracy of the procedure was 75%. There were no complications following any of the TBNAs.

Conclusions: In this small group of patients, TBNA was safe and had a high diagnostic accuracy in selected patients receiving mechanical ventilation in the ICU.

Key Words: bronchoscopy • diagnosis • HIV • human • lung cancer • mechanical ventilation • respiratory failure • transbronchial needle aspiration






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Copyright © 2002 by the American College of Chest Physicians.