Abstract

CARVALHO, Maria Verônica Costa Freire de et al. Concordance between tracheal aspirate and bronchoalveolar lavage in the diagnosis of ventilator associated pneumonia. J. bras. pneumol. [online]. 2004, vol.30, n.1, pp. 26-38. ISSN 1806-3713.  http://dx.doi.org/10.1590/S1806-37132004000100007.

BACKGROUND: The value of endotracheal aspirate cultures and of the GRAM stain test for the etiologic diagnosis of ventilator-associated pneumonia (VAP) still remains controversial. OBJECTIVES: To assess the consistency between the results of quantitative cultures and GRAM stain tests of the endotracheal aspirates and the bronchoalveolar lavage in patients with VAP. METHOD: Between October/2001 and August/2002, we prospectively studied all patients under mechanical ventilation for more than 48 hours with clinical suspicion of VAP. At the time of clinical suspicion, an endotrachealaspirate followed by a bronchoalveolar lavage was performed. Diagnosis of VAP was defined when clinical suspicion was confirmed by a positive quantitative culture (>104cfu/ml) in the bronchoalveolar lavage. RESULTS: Among 119 patients, 32 (26.8%) were suspected of having VAP, with confirmation in 25 (78%). Comparison between GRAM test of endotracheal aspirates and culture results of the bronchoalveolar lavage showed a moderate consistency (Kappa coefficient: 0.56). The was consistency between quantitative cultures of endotracheal aspirate and bronoalveolar lavage in 22 (88%) at the patients and no consistency in 3 (12%). (Kappa coefficient: 0.71). The sensitivity and specificity of the endotracheal aspirate culture with cut off of 106 cfu/m were 72% and 71%, respectively. CONCLUSION: The combination of GRAM stain test and quantitative cultures of the endotracheal aspirates may contribute to the diagnostic evaluation of VAP.

Keywords : Bronchoalveolar lavage [methods]; Pneumonia [diagnosis]; Respiration, Artificial; Prospectives studies.