Use of protected telescoping brush system in the management of bacterial pulmonary infection in intubated patients.

The diagnosis of pulmonary infection remains a major problem in the management of intubated patients with respiratory failure. We performed fibreoptic bronchoscopy and protected telescoping catheter brushing in 25 such patients, in order to assess the role of this technique in the diagnosis of bacterial pulmonary infection. All patients were intubated, demonstrated lung field opacities on chest radiograph and 23 had bacteria grown from tracheal aspirate culture. A single microorganism was recovered from plugged telescoping catheter (PTC) brush in eight patients, two or more organisms in nine patients and eight had a sterile culture. These results led to a specific management decision in 13 patients. All patients were ventilated with positive pressure and a pneumothorax, attributable to the procedure, developed in two. The difficulties in assessing the sensitivity and specificity of this technique in human studies are outlined. This procedure appears to have a useful role in the diagnosis of pneumonia in these patients and in further evaluating the importance of bacterial colonization of the airways and its relationship to parenchymal lung infection.