Tuesday December 26, 2006
Diagnosis of VAP - BAL vs endotracheal aspiration

Study published in this week's issue of The New England Journal of Medicine should be of interest for physicians getting burned with ventilator-associated pneumonia. Study was done to look into the optimal diagnostic approach in suspected ventilator-associated pneumonia - bronchoalveolar lavage with quantitative culture of the bronchoalveolar lavage vs endotracheal aspiration with nonquantitative culture of the aspirate.

Out of 740 patients there was no significant difference in the primary outcome (28-day mortality rate) between the two groups. Also there was no difference in the length of stay in the ICU or hospital. There was no difference in the use of targeted or no use of antibiotics.

Note: After the diagnostic tests had been completed, empirical antibiotic therapy was initiated in all patients until culture results were available. Patients randomly assigned to receive either IV meropenem (1 gram every 8 h) and IV ciprofloxacin (400 mg every 12 hours) or meropenem alone. With positive culture, antibiotic has been adjusted.

Clinical significance of the study: After start of empirical antibiotics in suspected ventilator-associated pneumonia, mode of diagnostic approach remains secondary. Performing bronchoalveolar lavage with quantitative culture does not provide any major benefit and may be avoided as routine practice to provide cost saving measure. Simple endotracheal aspiration provides the the same clinical outcome.



Reference: click to get abstract

A Randomized Trial of Diagnostic Techniques for Ventilator-Associated Pneumonia - The New England Journal of Medicine, Volume 355:2619-2630, Dec. 21, 2006