Diagnosing pneumonia in mechanically ventilated trauma patients: endotracheal aspirate versus bronchoalveolar lavage.
Diagnosing pneumonia in mechanically ventilated trauma patients: endotracheal aspirate versus bronchoalveolar lavage.
复制标题
诊断机械通气创伤患者的肺炎：气管内抽吸与支气管肺泡灌洗。
DOI：
10.1097/00005373-199310000-00003
复制
发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Read,RA
中科院分区：
文献类型：
--
作者：
Sauaia,A;Moore,FA;Moore,EE;Haenel,JB;Kaneer,L;Read,RA
我们前瞻性地比较了18例有肺炎临床症状的机械通气创伤患者气管内吸液（ETA）半定量（semiQC）和定量（QC）培养与支气管肺泡灌洗液（BAL） QC的诊断价值。当使用传统的QC截止点时，ETA和BAL的QC之间的总体一致性为89%，如果根据以前的抗生素治疗调整截止点，则为94%。6例临床诊断明确的肺炎患者，ETA和BAL QC均为阳性；然而，ETA的标准半质量控制在该组中显示出类似的结果。相反，在12例临床诊断不确定的患者中，10例患者的BAL和ETA QC为阴性，其中5例（50%）最终排除肺炎。所有患者的ETA半定量培养均为阳性。5例（28%）患者在BAL后2小时出现Pao 2/Fio 2下降（>为先前值的15%），3例（17%）患者这种紊乱持续了24小时。这些数据表明BAL对机械通气的创伤患者可能是危险的，它的使用应该限制在诊断有疑问的患者。
We prospectively investigated the diagnostic value of semiquantitative (semiQC) and quantitative (QC) cultures of endotracheal aspirate (ETA) compared with QC of bronchoalveolar lavage (BAL) fluids in 18 mechanically ventilated trauma patients with clinical signs of pneumonia. The general agreement between QC of ETA and BAL was 89% when conventional cutoffs for the QC were used and 94% if the cutoffs were adjusted for previous antibiotic therapy. In all six patients whose clinical diagnoses of pneumonia were considered definite, both QC of ETA and QC of BAL were positive; however, standard semiQC of ETA showed comparable results in this group. On the contrary, in the 12 patients whose clinical diagnoses were uncertain, QC of BAL and ETA were negative in ten patients and in five (50%) of these, pneumonia was eventually excluded. Semiquantitative cultures of ETA were positive in all these patients. Five (28%) patients experienced a decrease in Pao 2/Fio 2 (> 15% of previous value) 2 hours after BAL, and in three (17%) this derangement persisted for 24 hours. These data suggest that BAL may be hazardous in mechanically ventilated trauma patients and that its use should be restricted to patients in whom the diagnosis is in doubt.