Pneumonia in acute respiratory distress syndrome. A prospective evaluation of bilateral bronchoscopic sampling.
作者： G. UMBERTO MEDURI , RAJU C. REDDY , TIMMYE STANLEY , FATEN EL-ZEKY
DOI: 10.1164/AJRCCM.158.3.9706112
关键词:
摘要: We evaluated the diagnostic yield of bilateral bronchoalveolar lavage (BAL) in patients with acute respiratory distress syndrome (ARDS) suspected ventilator-associated pneumonia (VAP) and compared BAL results from contralateral sites. Ninety-four ARDS VAP underwent 172 bronchoscopies (344 BALs). was processed for quantitative cultures, total cell count subjected to microscopic analysis differential, presence intracellular organisms (ICO), Gram stain. The threshold a growth >= 10(4) cfu/ml culture. Most episodes (68%) had insignificant bacterial growth. Forty (43%) one or more VAP. Thirty-three 55 (60%) positive significant only side, 18 were right BAL, 15 left BAL. Episodes likely be polymicrobial, have 10(5) possess higher percentage neutrophils ICO. Among 65 microorganisms recovered concentration, Pseudomonas aeruginosa occurred 43% S. aureus 15%. Overall, stain sensitivity 54% specificity 87%; Giemsa (> 2% ICO) 46% 93%. Antibiotic treatment modified by cultures 50 (91%) pneumonia. In VAP, on side 19% both sides 13%.
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