Broncho alveolar lavage (BAL) is redundant in identifying organisms obtained from tracheal specimens in a trauma ICU

Bryan DeHaven, S. Ball, O. C. Kirton, David V Shatz, J. Morgan

Research output: Contribution to journalArticle

Abstract

Introduction: Protocols for the regulation and titration of antibiotics are frequently predicated on the growth of specific microorganisms and their sensitivities. The 'best' method of obtaining a culture sample is frequently debated, with both tracheal aspirates and bronchoalveolar lavage (both bronchoscopic and non-bronchoscopic) being suggested as appropriate for diagnosis of ventilator associated pneumonia (VAP) in the presence of SIRS or signs of sepsis. We chose to study what additional information was provided by BAL, as compared to tracheal aspirates, in the absence of specific clinical ordering guidelines. Methods: Descriptive study of ventilated Trauma ICU patients in a 20 bed unit who were cultured due to suspicion of ventilator associated pneumonia (VAP). Prospective cohort data collection over 18 months, with microbiological cultures compared for types of organisms, amount and quantity of growth. BAL culture was not available on weekends and after 4:00 pm weekdays, frequently resulting in BAL and tracheal cultures within 48 hours of each other. Results: 117 paired cultures (both BAL and tracheal samples sent from the same patient) were obtained: number percent Both Tracheal and BAL cultures 117 100%Tracheal and BAL sent w/in 48 hrs of each other 79 (of 117) 68% Same organism on tracheal & BAL sent w/in 48 h 59 (of 79) 75% Same organism on tracheal & BAL both heavy growth(tracheal) & > 104 (BAL) 27 (of 59) 46% both moderate growth(tracheal) & > 104 (BAL) 6 (of 59) 10% both heavy growth(tracheal) & < 104 (BAL) 4 (of 59) 7% Conclusion: The data are suggestive of increased resource consumption; the cost of the BAL's was an additional $21,834.00 over the cost of tracheal specimen collection alone. BAL did not provide any additional microbial information, or clarification of the presence of VAP, in the majority of patients. Despite interest in the use of BAL as a 'new' procedure, 1] the yield seems fairly small, and 2] the culture seems unneeded if a tracheal specimen has been sent within the preceding 48 hours.

Original languageEnglish (US)
JournalCritical Care Medicine
Volume27
Issue number1 SUPPL.
StatePublished - 1999
Externally publishedYes

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Therapeutic Irrigation
Wounds and Injuries
Ventilator-Associated Pneumonia
Growth
Specimen Handling
Costs and Cost Analysis
Dimercaprol
Bronchoalveolar Lavage
Sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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Broncho alveolar lavage (BAL) is redundant in identifying organisms obtained from tracheal specimens in a trauma ICU. / DeHaven, Bryan; Ball, S.; Kirton, O. C.; Shatz, David V; Morgan, J.

In: Critical Care Medicine, Vol. 27, No. 1 SUPPL., 1999.

Research output: Contribution to journalArticle

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abstract = "Introduction: Protocols for the regulation and titration of antibiotics are frequently predicated on the growth of specific microorganisms and their sensitivities. The 'best' method of obtaining a culture sample is frequently debated, with both tracheal aspirates and bronchoalveolar lavage (both bronchoscopic and non-bronchoscopic) being suggested as appropriate for diagnosis of ventilator associated pneumonia (VAP) in the presence of SIRS or signs of sepsis. We chose to study what additional information was provided by BAL, as compared to tracheal aspirates, in the absence of specific clinical ordering guidelines. Methods: Descriptive study of ventilated Trauma ICU patients in a 20 bed unit who were cultured due to suspicion of ventilator associated pneumonia (VAP). Prospective cohort data collection over 18 months, with microbiological cultures compared for types of organisms, amount and quantity of growth. BAL culture was not available on weekends and after 4:00 pm weekdays, frequently resulting in BAL and tracheal cultures within 48 hours of each other. Results: 117 paired cultures (both BAL and tracheal samples sent from the same patient) were obtained: number percent Both Tracheal and BAL cultures 117 100{\%}Tracheal and BAL sent w/in 48 hrs of each other 79 (of 117) 68{\%} Same organism on tracheal & BAL sent w/in 48 h 59 (of 79) 75{\%} Same organism on tracheal & BAL both heavy growth(tracheal) & > 104 (BAL) 27 (of 59) 46{\%} both moderate growth(tracheal) & > 104 (BAL) 6 (of 59) 10{\%} both heavy growth(tracheal) & < 104 (BAL) 4 (of 59) 7{\%} Conclusion: The data are suggestive of increased resource consumption; the cost of the BAL's was an additional $21,834.00 over the cost of tracheal specimen collection alone. BAL did not provide any additional microbial information, or clarification of the presence of VAP, in the majority of patients. Despite interest in the use of BAL as a 'new' procedure, 1] the yield seems fairly small, and 2] the culture seems unneeded if a tracheal specimen has been sent within the preceding 48 hours.",
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AU - DeHaven, Bryan

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AU - Morgan, J.

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N2 - Introduction: Protocols for the regulation and titration of antibiotics are frequently predicated on the growth of specific microorganisms and their sensitivities. The 'best' method of obtaining a culture sample is frequently debated, with both tracheal aspirates and bronchoalveolar lavage (both bronchoscopic and non-bronchoscopic) being suggested as appropriate for diagnosis of ventilator associated pneumonia (VAP) in the presence of SIRS or signs of sepsis. We chose to study what additional information was provided by BAL, as compared to tracheal aspirates, in the absence of specific clinical ordering guidelines. Methods: Descriptive study of ventilated Trauma ICU patients in a 20 bed unit who were cultured due to suspicion of ventilator associated pneumonia (VAP). Prospective cohort data collection over 18 months, with microbiological cultures compared for types of organisms, amount and quantity of growth. BAL culture was not available on weekends and after 4:00 pm weekdays, frequently resulting in BAL and tracheal cultures within 48 hours of each other. Results: 117 paired cultures (both BAL and tracheal samples sent from the same patient) were obtained: number percent Both Tracheal and BAL cultures 117 100%Tracheal and BAL sent w/in 48 hrs of each other 79 (of 117) 68% Same organism on tracheal & BAL sent w/in 48 h 59 (of 79) 75% Same organism on tracheal & BAL both heavy growth(tracheal) & > 104 (BAL) 27 (of 59) 46% both moderate growth(tracheal) & > 104 (BAL) 6 (of 59) 10% both heavy growth(tracheal) & < 104 (BAL) 4 (of 59) 7% Conclusion: The data are suggestive of increased resource consumption; the cost of the BAL's was an additional $21,834.00 over the cost of tracheal specimen collection alone. BAL did not provide any additional microbial information, or clarification of the presence of VAP, in the majority of patients. Despite interest in the use of BAL as a 'new' procedure, 1] the yield seems fairly small, and 2] the culture seems unneeded if a tracheal specimen has been sent within the preceding 48 hours.

AB - Introduction: Protocols for the regulation and titration of antibiotics are frequently predicated on the growth of specific microorganisms and their sensitivities. The 'best' method of obtaining a culture sample is frequently debated, with both tracheal aspirates and bronchoalveolar lavage (both bronchoscopic and non-bronchoscopic) being suggested as appropriate for diagnosis of ventilator associated pneumonia (VAP) in the presence of SIRS or signs of sepsis. We chose to study what additional information was provided by BAL, as compared to tracheal aspirates, in the absence of specific clinical ordering guidelines. Methods: Descriptive study of ventilated Trauma ICU patients in a 20 bed unit who were cultured due to suspicion of ventilator associated pneumonia (VAP). Prospective cohort data collection over 18 months, with microbiological cultures compared for types of organisms, amount and quantity of growth. BAL culture was not available on weekends and after 4:00 pm weekdays, frequently resulting in BAL and tracheal cultures within 48 hours of each other. Results: 117 paired cultures (both BAL and tracheal samples sent from the same patient) were obtained: number percent Both Tracheal and BAL cultures 117 100%Tracheal and BAL sent w/in 48 hrs of each other 79 (of 117) 68% Same organism on tracheal & BAL sent w/in 48 h 59 (of 79) 75% Same organism on tracheal & BAL both heavy growth(tracheal) & > 104 (BAL) 27 (of 59) 46% both moderate growth(tracheal) & > 104 (BAL) 6 (of 59) 10% both heavy growth(tracheal) & < 104 (BAL) 4 (of 59) 7% Conclusion: The data are suggestive of increased resource consumption; the cost of the BAL's was an additional $21,834.00 over the cost of tracheal specimen collection alone. BAL did not provide any additional microbial information, or clarification of the presence of VAP, in the majority of patients. Despite interest in the use of BAL as a 'new' procedure, 1] the yield seems fairly small, and 2] the culture seems unneeded if a tracheal specimen has been sent within the preceding 48 hours.

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