Chest
ArticlesThe Standardization of Bronchoscopic Techniques for Ventilator-Associated Pneumonia
Section snippets
Background
The most common complication encountered during or after diagnostic fiberoptic bronchoscopy (FOB) with PSB and BAL in patients receiving mechanical ventilation is a drop in PaO2.1, 2 In one study, significant hypoxemia (PaO2 <60 mm Hg on 80 percent FIO2) was observed in 14 of 117 patients (12 percent) and was linked to severity of pulmonary dysfunction and decrease in alveolar ventilation. Hypoxemia was more frequent in patients with adult respiratory distress syndrome (ARDS) and in those who
Background
Diagnostic bronchoscopy should be performed with due caution and continuous monitoring of exhaled volumes and oxygen saturation. Hypoventilation can be minimized by decreasing peak inspiratory flow, increasing ventilatory rate, and adjusting peak pressure alarms. Monitoring of exhaled tidal volume allows for best titration of ventilator settings. Hypoxemia and patient-ventilator asynchrony is minimized by delivering a high FIO2 (100 percent) and providing adequate sedation with or without
Background
Selection of the sampling area may be important in obtaining meaningful results. The sampling area is selected based on the location of the new or progressive infiltrate on chest radiograph or the segment visualized during bronchoscopy as having purulent secretions. Selection may be difficult in patients with diffuse infiltrates. In the immunosuppressed host with diffuse infiltrates (including ventilated patients), bilateral sampling has been advocated.9 One group has advocated bilateral
Background
Fiberoptic bronchoscopy provides direct access to the lower airways for sampling bronchial and parenchymal tissues. To reach the bronchial tree, however, the bronchoscope has to traverse the endotracheal tube, where contamination of the instrument is likely to occur with introduction into the suction channel of organisms contaminating (aspirated from above the ET cuff) or colonizing the endotracheal tube and the central airways.19, 20 Suction through the working channel of the FOB before
Definition of Satisfactory Respiratory Specimens
Protected Specimen Brushing: The literature does not provide criteria to assess the adequacy of a PSB specimen. Hemorrhage is an occasional complication of brushing, but the effects of hemorrhage on culture results have not been reported.
Bronchoalveolar Lavage: In a study of nonventilated patients, Kahn and Jones30 showed that the recovery of more than 1 percent squamous epithelial cells (SEC) in the cytocentrifuged BAL specimen was an accurate predictor of heavy contamination by oropharyngeal
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Contributors: John B. Bass, M.D.; Robert P Baughman, M.D.; Felipe Rodriquez De Castro, M.D.; M. C. Dombret, M.D.; Charles-Hugo Marquette; Maj Robert M. Mid4leton III, M.D.; Antonio Torres, M.D.; RlcharclH. Wlnterbauer, M.D.