THE STUDY OF THE EFFICIENCY OF A NEW AND CHEAP AND SAFE METHOD IN ACQUIRING A MINI-BRONCHOALVEOLAR LAVAGE SAMPLE FOR DIAGNOSIS OF VENTILATOR-ASSOCIATED PNEUMONIA: AN INITIAL EGYPTIAN TRIAL

Abstract

PURPOSE: As physicians in a developing country cost effectiveness is an important consideration. Previously the diagnosis of VAP was performed using expensive procedures, this lead us to develop a cheap, available and safe method of Mini Bronchoalveolar lavage (BAL) sampling. Our new method was studied in comparison with classical BAL and Endotracheal Aspirate (ETA) sampling. METHODS: Prospective clinical study performed at the respiratory Critical care unit. 40 patients (mean age 48.77 +/- 12.59) with suspected VAP according to the American Thoracic Society (ATS) guidelines 2005, underwent sampling through our new mini-BAL method, bronchoscopic BAL and ETA to confirm diagnosis. A nelaton catheter size 18 FG was used as the outer protective catheter , an infant ryle catheter (30) was used as the inner one , the outer catheter was blocked by sterile K-Ygel instead of the red polyethelene protective red plug in the original Combicath catheter. All samples where studied bacteriologically quantitatively and qualitatively. Results where further correlated and statistically analyzed. RESULTS: Out of the 40 suspected patients 35 where diagnosed by BAL and mini-BAL to be suffering from VAP. Using the Kappa test there was perfect agreement between BAL and min-BAL as regards the diagnosis of VAP , on the contrary the ETA showed no agreement. Maximum positive correlation(1) was reported amidst the BAL and the mini BAL, which was also highly significant (p = 0). In addition the mini-BAL sensitivity and specificity was 100% while the ETA revealed a sensitivity of 100% but a specificity of 0%. The new method did not record any complications or morbidity. The cost of the new mini-BAL method was 3 $while the classical BAL cost was 70$ per patient. CONCLUSION: The new sampling method proved to be highly effective sensitive and as specific as the classical BAL. However it has the advantage in being much cheaper , non invasive and does not require the expertise for preforming bronchoscopic sampling. CLINICAL IMPLICATIONS: Cost effective ,non invasive and early VAP diagnostic tool