[Management of patients with severe pneumonia in mechanical ventilation: usefulness of bronchoalveolar lavage].

UNLABELLED

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.

AIM

To asses the diagnostic value of bronchoalveolar lavage (BAL) in patients with suspicion of bacterial pneumonia in mechanical ventilation.

PATIENTS

We evaluated 73 community-acquired pneumonia and 94 nosocomial pneumonia in critically ill and mechanically ventilated patients.

RESULTS

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.