Saldías F, Blacutt M, Moreno R
Departamento de Enfernedades Respiratorias, Universidad Católica de Chile, Santiago de Chile.
Rev Med Chil. 1996 Aug;124(8):950-8.
Bacterial pneumonia is a frequent complication in patients requiring mechanical ventilation (9-21%) and carries a significant mortality. The optimal management of these patients remains controversial. Some investigators have advocated invasive diagnostic testing using bronchoscopic techniques.
To asses the diagnostic value of bronchoalveolar lavage (BAL) in patients with suspicion of bacterial pneumonia in mechanical ventilation.
We evaluated 73 community-acquired pneumonia and 94 nosocomial pneumonia in critically ill and mechanically ventilated patients.
The mortality was 50% (82 patients) and the principal death's cause was pulmonary sepsis (90%). 157 subjects received antibiotics before the microbiologic exam (94%) and 30 patients had multiple organ failure (MOF). Seventy of 167 BAL culture samples demonstrated microbial growth of > 10(4) cfu/ml (sensitivity: 41.9%). BAL culture samples isolated gram-positive cocci in 27 cases (39%), aerobic gram-negative bacilli in 39 cases (57%) and P carinii in 3 cases (4%). Correlation between BAL culture and hemocultive results was very insignificant. Prognosis of community-acquired pneumonia and nosocomial pneumonia were very bad in both cases. Mortality of patients with MOF (73%) was higher than patients without MOF (44.8%), (p < 0.01). Mortality was similar in patients with BAL culture positive (48.6%) and negative (49.5%). The mortality rate of severe pneumonia in MV was very elevated and the BAL culture results didn't affect significantly the survival.
细菌性肺炎是需要机械通气患者常见的并发症（9%-21%），且死亡率较高。这些患者的最佳治疗方案仍存在争议。一些研究者主张采用支气管镜技术进行侵入性诊断检测。
评估支气管肺泡灌洗（BAL）对怀疑患有细菌性肺炎的机械通气患者的诊断价值。
我们评估了73例社区获得性肺炎和94例医院获得性肺炎的重症及机械通气患者。
死亡率为50%（82例患者），主要死亡原因是肺部感染（90%）。157名受试者在微生物学检查前接受了抗生素治疗（94%），30例患者出现多器官功能衰竭（MOF）。167份BAL培养样本中有70份显示微生物生长>10(4) cfu/ml（敏感性：41.9%）。BAL培养样本分离出革兰氏阳性球菌27例（39%），需氧革兰氏阴性杆菌39例（57%），卡氏肺孢子虫3例（4%）。BAL培养结果与血培养结果之间的相关性非常低。社区获得性肺炎和医院获得性肺炎的预后都很差。患有MOF的患者死亡率（73%）高于未患MOF的患者（44.8%），（p<0.01）。BAL培养结果为阳性（48.6%）和阴性（49.5%）的患者死亡率相似。机械通气患者中重症肺炎的死亡率非常高，BAL培养结果对生存率没有显著影响。
