Tepper John, Johnson Sean, Parker Connor, Collins James, Menard Laura, Hinkle Laura
Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
J Intensive Care Med. 2023 Dec;38(12):1099-1107. doi: 10.1177/08850666231193379. Epub 2023 Aug 7.
Despite its widespread use, there are no direct studies comparing mini-bronchoalveolar lavage (mini-BAL) to bronchoscopic bronchoalveolar lavage (BAL) for diagnosing pneumonia in ventilated patients. The aim of this study was to perform a systematic review of studies comparing ventilated patients undergoing both bronchoscopic BAL and mini-BAL, to determine the mini-BAL's diagnostic accuracy. We conducted a systematic review searching the databases PubMed (MEDLINE), EMBASE, Cochrane Library, Scopus, and clinicaltrials.gov from inception until January 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms included variations on "pneumonia," "critical illness," and "mini-bronchoalveolar lavage." Article screening and data extraction were performed independently by 2 reviewers. Our search yielded 4296 abstracts. This was narrowed to 6 studies in which each patient underwent both mini-BAL and bronchoscopic BAL in succession. Included patients had a mean APACHE II score of 20.02 ± 3.81 and 15.95 ± 11.46 ventilator days. The sensitivity of the mini-BAL for diagnosis of pneumonia was 0.90 (95% confidence interval [CI]: 0.778-1.000) and the specificity was 0.827 (95% CI: 0.716-0.938). Limitations included inconsistency in volume of saline instilled and heterogeneity in included patients This study is the first to compile data from multiple publications directly comparing the mini-BAL to bronchoscopic BAL for diagnosing pneumonia in ventilated patients. Our data demonstrate a high degree of both sensitivity and specificity of mini-BAL for the diagnosis of pneumonia in ventilated patients and indicate that mini-BAL could be considered as an acceptable alternative diagnostic study.
尽管其应用广泛，但尚无直接研究比较微型支气管肺泡灌洗术（mini - BAL）与支气管镜下支气管肺泡灌洗术（BAL）在诊断机械通气患者肺炎方面的效果。本研究的目的是对比较接受支气管镜BAL和mini - BAL的机械通气患者的研究进行系统评价，以确定mini - BAL的诊断准确性。我们按照系统评价和Meta分析的首选报告项目指南，对数据库PubMed（MEDLINE）、EMBASE、Cochrane图书馆、Scopus和clinicaltrials.gov进行了系统检索，检索时间从建库至2022年1月。检索词包括“肺炎”“危重病”和“微型支气管肺泡灌洗术”的变体。文章筛选和数据提取由两名审阅者独立进行。我们的检索共获得4296篇摘要。筛选后纳入6项研究，这些研究中每位患者均依次接受了mini - BAL和支气管镜BAL。纳入患者的急性生理与慢性健康状况评分系统（APACHE II）平均得分为20.02±3.81，机械通气天数为15.95±11.46天。mini - BAL诊断肺炎的敏感性为0.90（95%置信区间[CI]：0.778 - 1.000），特异性为0.827（95% CI：0.716 - 0.938）。局限性包括注入生理盐水的量不一致以及纳入患者的异质性。本研究首次汇总了多个出版物中直接比较mini - BAL与支气管镜BAL在诊断机械通气患者肺炎方面的数据。我们的数据表明，mini - BAL在诊断机械通气患者肺炎方面具有高度的敏感性和特异性，提示mini - BAL可被视为一种可接受的替代诊断方法。
