Butler Karyn L, Best Irwin M, Oster Robert A, Katon-Benitez Iva, Lynn Weaver Wm, Bumpers Harvey L
Morehouse School of Medicine, Department of Surgery, Atlanta, Georgia 30310, USA.
J Trauma. 2004 Aug;57(2):316-22. doi: 10.1097/01.ta.0000088858.22080.cb.
Clinical acumen alone is unreliable in establishing a diagnosis of ventilator-associated pneumonia (VAP) and controversy exists over which diagnostic tools should be utilized to confirm a clinical suspicion of VAP. The purpose of this study was to determine the reliability of blind protected specimen brush (PSB) sampling in the diagnosis of VAP and if bilateral PSB sampling is necessary.
Prospective study comparing blind PSB sampling with bronchoscopic directed PSB sampling in thirty-four consecutive SICU patients with a clinical suspicion of VAP. All patients underwent blind PSB sampling followed by bronchoscopic directed contralateral PSB sampling.
Twenty-four of 34 patients (71%) were diagnosed to have VAP. The concordance rate between blind and directed PSB samples was 53% (18/34). When blind PSB was positive (15/34), the contralateral sample yielded a different microorganism in three patients (9%). When blind PSB was negative (19/34), infection was present in the contralateral lung in nine patients (26%). Blind PSB sampling alone was inaccurate in 35% of patients.
The low concordance between blind and directed PSB suggests the need to sample both lung fields. Bilateral PSB sampling can identify unsuspected pathogenic microorganisms in the contralateral lung.
仅靠临床敏锐度来诊断呼吸机相关性肺炎（VAP）是不可靠的，并且对于应使用哪些诊断工具来证实临床怀疑的VAP存在争议。本研究的目的是确定盲法保护性标本刷检（PSB）采样在VAP诊断中的可靠性，以及双侧PSB采样是否必要。
前瞻性研究，比较34例临床怀疑VAP的连续入住外科重症监护病房（SICU）患者的盲法PSB采样与支气管镜引导下PSB采样。所有患者均先进行盲法PSB采样，然后进行支气管镜引导下对侧PSB采样。
34例患者中有24例（71%）被诊断为VAP。盲法和引导法PSB样本的一致性率为53%（18/34）。当盲法PSB为阳性时（15/34），对侧样本在3例患者（9%）中检出不同微生物。当盲法PSB为阴性时（共19例，占34例的56%），9例患者（26%）对侧肺存在感染。仅采用盲法PSB采样时，35%的患者诊断不准确。
盲法和引导法PSB之间的低一致性表明需要对双侧肺野进行采样。双侧PSB采样可识别对侧肺中未被怀疑的致病微生物。
