Evaluation of Blind Nasotracheal Suctioning and Non bronchoscopic Mini-Bronchoalveolar Lavage in Critically Ill Patients with Infectious Pneumonia: A Preliminary Study
2014
BACKGROUND: We evaluated the diagnostic performance and safety of combined blind nasotracheal suctioning and non-bronchoscopic mini-bronchoalveolar lavage (mini-BAL) to obtain respiratory secretion specimens from spontaneously breathing, non-intubated patients with infectious pneumonia in intensive care.
METHODS: Patients suspected of having infectious pneumonia were included prospectively. Three samples were obtained: expectorated sputum, nasotracheal suctioning, and mini-BAL via a double telescopic catheter (Combicath). Under local anesthesia, nasotracheal suctioning was done according to standard recommendations. Then mini-BAL was performed; the bronchial catheter serves as a guide for the mini-BAL catheter, and tracheal position is verified via colorimetric capnography.
RESULTS: We included 36 subjects (29 men, median age 69 y, median Simplified Acute Physiology Score II 32), of which 32 (89%) underwent nasotracheal suctioning and mini-BAL, and from 13 (36%) we collected expectorated sputum. Based on colorimetric capnography confirmation of the tracheal position, 75% (24/32) of the successful combined procedures were achieved on the first attempt. The median duration of the combined procedure was 7 min. Bacterial pneumonia was diagnosed in 24/36 (67%) subjects, among whom 21 (88%) had undergone successful nasotracheal suctioning and mini-BAL, respectively, for 8/21 (38% [95% CI 0.17–0.58%] and 14/21 (67% [95% CI 0.46–0.86%]). Mini-BAL diagnosed a significantly higher percentage of bacterial pneumonias than did nasotracheal suctioning. Expectorated sputum yielded no diagnoses.
CONCLUSIONS: Blind nasotracheal suctioning confirmed via colorimetric capnography allows microbiological diagnosis, and can be enhanced by non-bronchoscopic mini-BAL. Colorimetric capnography helps confirm bronchial tube position. Non-bronchoscopic mini-BAL is a novel and feasible way to collect bronchial secretions without fibroscopy. (ClinicalTrials.gov [NCT00763620][1].)
[1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00763620&atom=%2Frespcare%2F59%2F3%2F345.atom
Keywords:
- Correction
- Source
- Cite
- Save
- Machine Reading By IdeaReader
38
References
8
Citations
NaN
KQI