Papazian L, Thomas P, Garbe L, Guignon I, Thirion X, Charrel J, Bollet C, Fuentes P, Gouin F
Department of Anesthesia and Intensive Care, Hôpital Sainte-Marguerite, Marseilles, France.
Am J Respir Crit Care Med. 1995 Dec;152(6 Pt 1):1982-91. doi: 10.1164/ajrccm.152.6.8520766.
The purpose of this prospective postmortem study was to assess the diagnostic accuracy of bronchoscopic techniques (bronchoalveolar lavage [BAL] and protected specimen brush [PSB]) and nonbronchoscopic techniques (blind bronchial sampling [BBS] and mini-BAL) in the diagnosis of ventilator-associated pneumonia (VAP). The results of each technique were compared with histology and culture of lung tissue specimens obtained by surgical pneumonectomies in 38 patients who died after at least 72 h of mechanical ventilation. Histology was positive for VAP in 18 patients and negative in 20 patients. There were 12 definite VAP (positive histology and positive lung cultures) and 6 histologic VAP (positive histology and negative cultures). Clinical pulmonary infection score (CPIS) at a threshold of 6 achieved a sensitivity of 72% and a specificity of 85%. When the CPIS was combined with the logarithmic concentration of the predominant microorganism obtained from the BBS sample culture, specificity was increased to 95%, for a threshold of 10. Using 10(3) cfu/ml as the threshold of positivity for cultures obtained with PSB and mini-BAL samples and 10(4) cfu/ml for cultures obtained with BBS and BAL, the respective sensitivities of these techniques for definite VAP were 42, 67, 83, and 58%. The sensitivity of BBS was significantly higher than that of PSB (p < 0.05). The area under the receiver operator characteristic curve was significantly greater for BBS than PSB (p < 0.05). Given that it is more sensitive and noninvasive, BBS is preferable to PSB for the diagnosis of VAP.
这项前瞻性尸检研究的目的是评估支气管镜技术（支气管肺泡灌洗[BAL]和保护性标本刷检[PSB]）及非支气管镜技术（盲法支气管采样[BBS]和微型BAL）在诊断呼吸机相关性肺炎（VAP）方面的诊断准确性。将每种技术的结果与38例在机械通气至少72小时后死亡的患者经手术肺切除获取的肺组织标本的组织学检查及培养结果进行比较。18例患者VAP组织学检查呈阳性，20例呈阴性。有12例确诊VAP（组织学阳性且肺部培养阳性）和6例组织学VAP（组织学阳性但培养阴性）。临床肺部感染评分（CPIS）阈值为6时，敏感性为72%，特异性为85%。当CPIS与从BBS样本培养获得的主要微生物的对数浓度相结合时，阈值为10时特异性提高到95%。以10³cfu/ml作为PSB和微型BAL样本培养的阳性阈值，以10⁴cfu/ml作为BBS和BAL样本培养的阳性阈值，这些技术对确诊VAP的各自敏感性分别为42%、67%、83%和58%。BBS的敏感性显著高于PSB（p<0.05）。BBS的受试者操作特征曲线下面积显著大于PSB（p<0.05）。鉴于BBS更敏感且无创，在诊断VAP方面比PSB更可取。
