The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

IMPLEMENTATION OF A BLINDED BRONCHIAL LAVAGE SAMPLING PROTOCOL

Sally Whitten, Christopher Hirsch, Robert Owens, Stephen Mette; Pulmonary & Critical Care Medicine, Maine Medical Center, Portland, ME

Background. Ventilator associated pneumonia (VAP), a common complication of ventilator care, can have a significant impact on morbidity and mortality. Adequate empiric antibiotic therapy should be initiated in patients with clinical evidence of the disease. Rapid identification of specific bacterial pathogens with implementation of appropriately targeted antibiotic therapy can improve outcomes in patients with suspected VAP. Our facility implemented a Respiratory Therapist (RT) protocol for obtaining tracheal aspirates via a blinded bronchial sampling or mini-broncho-alveolar-lavage (“mini-BAL”) technique. The goals of this program were to minimize the use of the less reliable method of obtaining sputum culture through endotracheal tube suctioning, to expediently provide culture results comparable to directed bronchoscopic alveolar lavage, and to potentially reduce antibiotic days. Methods. Prior to implementation, a multi-disciplinary group reviewed VAP literature and assessed the safety and ease of use of commercially available catheters. RTs were provided specific training, with competency assessed by direct observation of a pulmonologist. Physician entry of a mini-BAL order triggered the RT paging system so tracheal samples could be immediately obtained and processed. Educational efforts aimed at promoting a shift to mini-BAL or bronchoscope directed BAL were undertaken. Results. Prior to the utilization of the mini-BAL, 98% of sputum samples were obtained via endotracheal tube suctioning. This was decreased to 39%, with the remaining 61% obtained via either mini-BAL or bronchoscopic BAL. Since mid-2006, RTs have submitted 1317 mini-BAL specimens, of which 544 (41%) were positive (organisms present at greater than 104 cfu/mL). Over a threemonth interval, some 124 unnecessary antibiotic days were avoided by increasing usable microbiologic data. Conclusions. The protocol allows physicians to obtain quantitative bacteriology of alveolar fluid at any time. Rapid identification of pathogens allows the physician to precisely target antibiotic therapy. Prompt reductions in therapy, may decrease institutional antibiotic resistance development. No adverse patient events have been associated with the mini-BAL protocol or reduced antibiotic use. Sponsored Research - None

You are here: RCJournal.com » Past OPEN FORUM Abstracts » 2009 Abstracts » IMPLEMENTATION OF A BLINDED BRONCHIAL LAVAGE SAMPLING PROTOCOL