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The Bovine Lung in Biomedical Research: Visually Guided Bronchoscopy, Intrabronchial Inoculation and In Vivo Sampling Techniques
Published on: July 3, 2014
Diagnosis of ventilator-associated pneumonia in children in resource-limited setting: a comparative study of
Anil Sachdev1, Krishan Chugh, Manpreet Sethi
1Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India. anilcriticare@hotmail.com
Insights
Diagnosing ventilator-associated pneumonia in children requires effective methods. Blind bronchial sampling offers a reliable and cost-effective option for developing countries.
Area of Science:
- Pediatric critical care medicine
- Infectious disease diagnostics
- Respiratory medicine
Background:
- Ventilator-associated pneumonia (VAP) is a significant concern in intubated pediatric patients.
- Accurate diagnosis is crucial for appropriate treatment and improved patient outcomes.
- Existing diagnostic methods vary in efficacy and cost.
Purpose of the Study:
- To compare the diagnostic performance of various methods for VAP in pediatric patients.
- To identify a cost-effective diagnostic approach suitable for resource-limited settings.
Main Methods:
- A prospective study was conducted in a pediatric intensive care unit in India.
- Four diagnostic procedures were evaluated: tracheal aspiration, blind bronchial sampling, blind bronchoalveolar lavage, and bronchoscopic bronchoalveolar lavage.
- Bronchoscopic bronchoalveolar lavage served as the reference standard for bacterial density.
Main Results:
- Blind bronchoalveolar lavage demonstrated the highest diagnostic accuracy (90%), followed closely by blind bronchial sampling (87%).
- Tracheal aspiration showed lower sensitivity and specificity compared to the other methods.
- Blind bronchial sampling was significantly more cost-effective than blind bronchoalveolar lavage.
Conclusions:
- Blind bronchoalveolar lavage is the most reliable method for diagnosing VAP in this population.
- Given its lower cost and comparable reliability, blind bronchial sampling is recommended for VAP diagnosis in pediatric intensive care units in developing countries.
Objectives:
To compare the available methods for the diagnosis of ventilator-associated pneumonia in intubated pediatric patients and to suggest less costly diagnostic method for developing countries.
Design:
Prospective study.
Setting:
Pediatric intensive care unit of a tertiary care, multidisciplinary teaching hospital located in northern India.
Patients:
All consecutive patients on mechanical ventilation for >48 hrs were evaluated clinically for ventilator-associated pneumonia.
Interventions:
Four diagnostic procedures (tracheal aspiration, blind bronchial sampling, blind bronchoalveolar lavage, and bronchoscopic bronchoalveolar lavage) were performed in the same sequence within 12 hrs of clinical suspicion of ventilator-associated pneumonia. The bacterial density > or =104 colony-forming units/mL in a bronchoscopic bronchoalveolar lavage sample was taken as reference standard.
Measurements And Main Results:
Thirty patients with 40 episodes of ventilator-associated pneumonia were included in the study. Tracheal aspirate at the cutoff of > or =105 colony-forming units/mL was found to have sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 84%, 77%, 87.5%, 73%, and 80%, respectively. For blind bronchial sampling at > or =104 colony-forming units/mL cutoff, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 88%, 82%, 88%, 83%, and 87%, respectively; the most reliable results were obtained with blind bronchoalveolar lavage at the cutoff of > or =103 cfu/mL (sensitivity 96%, specificity 80%, positive predictive value 88%, negative predictive value 92%, and accuracy 90%). The area under the receiver operating characteristic curve of tracheal aspiration, blind bronchial sampling, and blind bronchoalveolar lavage was 0.87 +/- 0.06, 0.89 +/- 0.06, and 0.89 +/- 0.05, respectively. The cost of balloon-tip pressure catheter used for blind bronchoalveolar lavage was INR 1600.00 (US$40) whereas that for blind bronchial sampling was only INR 35.00 (<1 US$).
Conclusions:
Blind bronchoalveolar lavage was the most reliable method followed closely by blind bronchial sampling for the diagnosis of ventilator-associated pneumonia. Considering the difference of the cost in the two procedures, blind bronchial sampling may be the preferred method in the pediatric intensive care unit of a developing country.
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