USEFULNESS OF AIRWAY VISUALIZATION IN THE DIAGNOSIS OF NOSOCOMIAL PNEUMONIA IN VENTILATED PATIENTS

Clinical diagnosis of nosocomial pneumonia in ventilated patients rema ins a challenge in the ICU as none of the clinical biological acid rad iologic parameters can predict its diagnosis. To our knowledge, howeve r, the accuracy of direct visualization of the bronchial tree has neve r been investigated. Purpose: To evaluate the interest of airway visua lization and to select independent parameters that predict nosocomial pneumonia in ventilated patients. Setting: A ten-bed medical-surgical ICU. Methods: All consecutive patients suspected of having nosocomial pneumonia who underwent bronchoscopy with protected specimen brush, cu lture examination of BAL, and direct examination of BAL, were studied, Clinical and biological data and airways findings were recorded prosp ectively. Patients were classified as baring pneumonia or not accordin g to the results of distal bacteriologic samples, follow-up, and histo logic study, Respective accuracies of each variable were calculated us ing univariate analysis and stepwise logistic regression. Results: Nin ety-one patients with suspected nosocomial pneumonia were studied, Pat ients were randomly assigned to a construction group (n=46) and a vali dation group (n=15). Using multivariate analysis, 3 factors were assoc iated with pneumonia (a decrease in PaO2/fraction of inspired oxygen r atio greater than or equal to 50 mm Hg, odds ratio [OR]=9.97, p=0.026; the presence of distal purulent secretions, OR=7.46, p=0.044; the per sistence of distal secretions surging from distal bronchi during exhal ation, OR=12.25, p=0.013), These three factors remained associated wit h pneumonia in the validation group. Interobserver repeatability of th e bronchoscopic parameters was good. Having 2 or more of these 3 indep endent factors was able to predict pneumonia sith a 94% sensitivity an d a 89% specificity in the construction group and with a 78% sensitivi ty and a 89% specificity in the validation group. Conclusion: We concl ude that direct visualization of the bronchial tree can immediately an d accurately predict nosocomial pneumonia in ventilated patients befor e obtaining definite results of protected samples.