Comparison of nonbronchoscopic techniques with bronchoscopic brushing in the diagnosis of ventilator-associated pneumonia

Objective: To determine the diagnostic accuracy of quantitative cultures obtained via nonbronchoscopic protected specimen brushing (PSB) and nonbronchoscopic bronchoalveolar lavage (BAL) compared with quantitative cultures obtained by bronchoscopic PSB in surgical patients suspected of ventilator-associated pneumonia. Design: Prospective, crossover controlled study of 15 ventilated surgical intensive care unit patients in a university teaching hospital. Methods: Fifteen consecutive ventilated patients suspected of ventilator-associated pneumonia on the basis of leukocytosis, purulent sputum, and appearance of chest roentgenogram were enrolled. All patients underwent nonbronchoscopic PSB and BAL followed by bronchoscopic PSB. The duration of each procedure was noted. Culture results were considered positive only if greater than 10⁴ colony forming units (CFU) per milliliter were present. Main Results: Perfect concordance was noted between bronchoscopic PSB and nonbronchoscopic BAL (κ = 1.0). The concordance between bronchoscopic PSB and nonbronchoscopic PSB was 93% ((κ = 0.86). The nonbronchoscopic procedures were performed in significantly less time than the bronchoscopic procedure. Conclusion: Nonbronchoscopic PSB and BAL provide similar microbiologic data to bronchoscopic PSB in the diagnosis of ventilator-associated pneumonia while shortening procedure time significantly.