Background
Broncho-alveolar lavage (BAL) is an invasive bedside procedure to define type and
concentration of pathologic organisms causing ventilator associated pneumonia (VAP).
We evaluated if the absence of pathogens on final results represented a lavage aspect
of the BAL as a therapeutic procedure to eliminate organisms.
Methods
BAL results collected from 2008 to 2009 were stratified as positive (POS) ≥100,000
cfu), indeterminate (INT)≤100,000 cfu pathologic organisms, or negative defined as
mixed flora (MF) or sterile (STR). The INT, MF, and STR results were assessed by incidence
of a subsequent POS sample.
Results
Nine-hundred forty-nine BALs performed on 490 SICU patients were interpreted as POS
in 227 patients (46%). 237 non- POS patients needed a subsequent BAL. Any pathogen
on the first BAL (INT group) indicates a high likelihood for subsequent BAL which
will be POS. Monthly cumulative sum analysis (CUSUM) of yield was unable to identify
any specific period in which BAL performance varied from trend.
Conclusion
MF and STR represent adequate sampling of secretions that are clinically benign. Any
pathogen, regardless of concentration, should be considered a biomarker for future
pneumonia. CUSUM analysis suggest better training in timing and indication may decrease
unnecessary procedures yielding negative results.
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Article info
Publication history
Accepted:
July 11,
2011
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
