F. Saldias et al., UTILITY OF BRONCHOALVEOLAR LAVAGE IN THE MANAGEMENT OF PATIENTS WITH SEVERE PNEUMONIA IN MECHANICAL VENTILATION, Revista Medica de Chile, 124(8), 1996, pp. 950-958
Bacterial pneumonia is a frequent complication in patients requiring m
echanical ventilation (9-21%) and carries a significant mortality. The
optimal management of these patients remains controversial. Some inve
stigators have advocated invasive diagnostic testing using bronchoscop
ic techniques. Aim: To asses the diagnostic value of bronchoalveolar l
avage (BAL) in patients with suspicion of bacterial pneumonia in mecha
nical ventilation. Patients: We evaluated 73 community-acquired pneumo
nia and 94 nosocomial pneumonia in critically ill and mechanically ven
tilated patients. Results: The mortality was 50% (82 patients) and the
principal death's cause was pulmonary sepsis (90%). 157 subjects rece
ived antibiotics before the microbiologic exam (94%) and 30 patients h
ad multiple organ failure (MOF). Seventy of 167 BAL culture samples de
monstrated microbial growth of >10(4) cfu/ml (sensivity: 41.9%). BAL c
ulture samples isolated gram-positive cocci in 27 cases (39%), aerobic
gram-negative bacilli in 39 cases (57%) and P carinii in 3 cases (4%)
. Correlation between BAL culture and hemocultive results was very ins
ignificant. Prognosis of community-acquired pneumonia and nosocomial p
neumonia were very bad in both cases. Mortality of patients with MOF (
73%) was higher than patients without MOF (44.8%), (p<0,01). Mortality
was similar in patients with BAL culture positive (48,6%) and negativ
e (49,5%). The mortality rate of severe pneumonia in MV was very eleva
ted and the BAL culture results didn't affect significatively the surv
ival.