Kollef M H, Bock K R, Richards R D, Hearns M L
Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, MO 63110, USA.
Ann Intern Med. 1995 May 15;122(10):743-8. doi: 10.7326/0003-4819-122-10-199505150-00002.
To assess the safety of minibronchoalveolar lavage done by respiratory therapists for the evaluation of suspected ventilator-associated pneumonia and to determine the diagnostic agreement between quantitative lower airway cultures obtained by the minibronchoalveolar lavage and protected specimen brush techniques.
A prospective direct comparison of two diagnostic techniques.
An academic tertiary care center in St. Louis, Missouri.
72 consecutive patients suspected of having ventilator-associated pneumonia on the basis of clinical evidence.
Sampling of lower airway secretions using the protected specimen brush and minibronchoalveolar lavage techniques.
Clinical complications and quantitative cultures of respiratory secretions.
72 patients suspected of having ventilator-associated pneumonia (first episode) were evaluated using minibronchoalveolar lavage. In 42 patients, lower airway secretions were also obtained using the protected specimen brush technique. No change in arterial blood oxygen saturation or heart rate occurred after minibronchoalveolar lavage (P > 0.2). Mean arterial pressure slightly increased with minibronchoalveolar lavage (baseline mean pressure, 90.1 mm Hg [CI, 88.4 to 91.7 mm Hg]; average within-person change, 2.6 mm Hg; P = 0.024). Good diagnostic agreement was shown for quantitative cultures obtained with the protected specimen brush and minibronchoalveolar lavage techniques (kappa statistic, 0.63; concordance, 83.3%); 10(3) colony forming units/mL was used as the threshold for a clinically significant culture result.
Minibronchoalveolar lavage is a safe and technically simple procedure for obtaining quantitative lower airway cultures in patients requiring mechanical ventilation. Quantitative culture results obtained by minibronchoalveolar lavage are similar to those obtained by the protected specimen brush technique.
评估呼吸治疗师进行的微型支气管肺泡灌洗在疑似呼吸机相关性肺炎评估中的安全性，并确定通过微型支气管肺泡灌洗和保护性标本刷技术获得的定量下呼吸道培养物之间的诊断一致性。
两种诊断技术的前瞻性直接比较。
密苏里州圣路易斯的一家学术性三级医疗中心。
72例基于临床证据疑似患有呼吸机相关性肺炎的连续患者。
使用保护性标本刷和微型支气管肺泡灌洗技术对下呼吸道分泌物进行采样。
临床并发症和呼吸道分泌物的定量培养。
72例疑似患有呼吸机相关性肺炎（首发）的患者接受了微型支气管肺泡灌洗评估。其中42例患者还使用保护性标本刷技术获取了下呼吸道分泌物。微型支气管肺泡灌洗后动脉血氧饱和度或心率无变化（P>0.2）。微型支气管肺泡灌洗后平均动脉压略有升高（基线平均压力，90.1 mmHg [CI，88.4至91.7 mmHg]；个体内平均变化，2.6 mmHg；P = 0.024）。保护性标本刷和微型支气管肺泡灌洗技术获得的定量培养物显示出良好的诊断一致性（kappa统计量，0.63；一致性，83.3%）；将10(3) 菌落形成单位/毫升用作具有临床意义的培养结果的阈值。
微型支气管肺泡灌洗是一种安全且技术上简单的方法，可用于需要机械通气的患者获取定量下呼吸道培养物。微型支气管肺泡灌洗获得的定量培养结果与保护性标本刷技术获得的结果相似。
