Solé-Violán J, Rodríguez de Castro F, Rey A, Martín-González J C, Cabrera-Navarro P
Intensive Care Division, Hospital Ntra. Sra. del Pino. Facultad de Ciencias de la Salud, Universidad de Las Palmas, Las Palmas de Gran Canaria, Spain.
Chest. 1994 Sep;106(3):889-94. doi: 10.1378/chest.106.3.889.
To assess the usefulness of quantification of bronchoalveolar lavage (BAL) cells containing intracellular organisms (ICO) in the diagnosis of ventilator-associated pneumonia.
The reliability of cytologic analysis in comparison with the protected specimen brush (PSB) and BAL quantitative cultures has been assessed in a prospective study.
An intensive care unit of a tertiary-referral teaching hospital.
A total of 33 ventilated patients with suspected pneumonia based on clinical grounds and radiographic findings.
All patients underwent fiberoptic bronchoscopy within the first 24 h after clinical suspicion of pneumonia. Specimens were obtained by PSB and BAL and were processed for quantitative cultures using standard methods. Two 0.5-ml samples of resuspended original BAL fluid were centrifuged and stained with Gram and modified May-Grünwald-Giemsa for differential cell counts and percentage of cells with ICO.
Pneumonia was the final diagnosis in 16 (49 percent) of the 33 patients. In 14 (42 percent) patients, pneumonia was excluded and in the remaining 3 the diagnosis was uncertain. Twelve of the 16 patients with pneumonia had their conditions diagnosed by PSB, 14 by BAL, and 10 by quantification of ICO. Only one patient's condition was diagnosed exclusively by cytologic examination. There were no false-positive results with any of the diagnostic techniques.
Microscopic identification of ICO in cells recovered by BAL allows early and accurate diagnosis of pneumonia in mechanically ventilated patients. However, the sensitivity of this technique is lower than with either PSB or BAL.
评估对含有细胞内病原体（ICO）的支气管肺泡灌洗（BAL）细胞进行定量分析在呼吸机相关性肺炎诊断中的作用。
在一项前瞻性研究中评估了细胞学分析与保护性标本刷检（PSB）及BAL定量培养相比的可靠性。
一所三级转诊教学医院的重症监护病房。
基于临床症状和影像学表现，共有33例疑似肺炎的机械通气患者。
所有患者在临床怀疑肺炎后的最初24小时内接受纤维支气管镜检查。通过PSB和BAL获取标本，并采用标准方法进行定量培养。将两份0.5毫升重悬的原始BAL液样本离心，并用革兰氏染色和改良美蓝-吉姆萨染色进行细胞分类计数及含ICO细胞的百分比分析。
33例患者中，最终诊断为肺炎的有16例（49%）。14例（42%）患者排除了肺炎，其余3例诊断不明确。16例肺炎患者中，12例通过PSB确诊，14例通过BAL确诊，10例通过ICO定量分析确诊。仅1例患者的病情仅通过细胞学检查确诊。任何一种诊断技术均未出现假阳性结果。
对BAL回收细胞中的ICO进行显微镜鉴定可实现对机械通气患者肺炎的早期准确诊断。然而，该技术的敏感性低于PSB或BAL。
