Marin H. Kollef, MD
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Kollef MH. Minibronchoalveolar Lavage by Respiratory Therapists. Ann Intern Med. 1996;124:275. doi: 10.7326/0003-4819-124-2-199601150-00022
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Published: Ann Intern Med. 1996;124(2):275.
I agree that we currently lack adequate clinical data supporting the routine use of bronchoscopic or nonbronchoscopic lower-airway sampling for the evaluation of suspected ventilator-associated pneumonia . This is due, in part, to the limitations of these techniques, including the need for physician performance of bronchoscopy, and the lack of outcome data suggesting any benefit from the use of these techniques compared with routine clinical management. Prospective trials are required to determine the clinical efficacy and cost-effectiveness of these diagnostic techniques.
Antibiotic administration is recognized as an important limitation of lower-airway sampling methods, which primarily result in false-negative cultures despite the histologic presence of pneumonia [2, 3]. Having readily available lower-airway sampling techniques such as minibronchoalveolar lavage or quantitative cultures of endotracheal aspirates, which do not depend on a physician, allows respiratory cultures to be more easily obtained before antibiotic therapy is begun or changed . Additionally, obtaining endobronchial cultures from specific lung segments does not appear to be necessary because ventilator-associated pneumonia is a multifocal process usually involving dependent lung regions that can be blindly sampled by minibronchoalveolar lavage . The pathophysiologic and histologic characteristics of ventilator-associated pneumonia, along with the results from a recent bronchoscopic study, do not support the need for selective endobronchial sampling of specific lung segments to establish this diagnosis .
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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