The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

CLINICAL USE OF NON-BRONCHOSCOPIC BRONCHOALVEOLAR LAVAGE CATHETER IN MECHANICALLY VENTILATED PATIENTS

John S. Emberger1, Robert Donnelly1, Montee Amy1, Michael DePietro2



Background: Both community acquired and ventilator associated pneumonia is a common problem in the ICU. Rapid identification of pulmonary organisms is beneficial for treatment with appropriate antibiotic agents. We recently began using a non-bronchoscopic bronchoalveolar lavage catheter (BAL-CATH) designed to obtain a lower lung specimen. We wanted to determine if the BAL-CATH is helping to detect significant infections requiring antibiotic treatment.

Methods: We retrospectively reviewed a random population of mechanically ventilated patients known to have had a BAL-CATH procedure. We collected patient demographics, mortality, BAL-CATH culture results and all antibiotic use. We analyzed "No Growth" results for discontinued antibiotics. We analyzed positive culture results for the addition of appropriate antibiotics. We also analyzed mortality and age.

Results: BAL-CATH results on 83 mechanically ventilated patients were examined. Before BAL-CATH results were available (in culture at the laboratory): 70% of Gram (-) patients were appropriately covered and 37% percent of Gram (+) patients were appropriately covered. After BAL-CATH results were available (final report from laboratory): 83% of "no growth" patients had one or more antibiotics discontinued and 100% of patients with growth (> 10,000 cfu/ml) had appropriate antibiotics. All patients with yeast that died, had complicated medical courses and it was difficult to determine if lung infection was primary cause of death.

Conclusion:

  1. BAL-CATH has resulted in the discontinuation of antibiotics not clinically indicated.
  2. BAL-CATH has resulted in the initiation of appropriate antibiotic coverage.
  3. Gram (+) results were associated with mortality double that of Gram (-).
  4. Gram (+) infections may not have been empirically covered as well as Gram (-) infections, since only 37% were covered before BAL-CATH results were available.
  5. The difference in mortality rate of Gram (+) and Gram (-) may partially be caused by empiric coverage (before BAL-CATH results were available).
  6. Though yeast colonized patients were associated with complicated medical courses, yeast colonization may not be as benign as typically assumed.