UTILITY OF BRONCHOALVEOLAR LAVAGE IN THE MANAGEMENT OF PATIENTS WITH SEVERE PNEUMONIA IN MECHANICAL VENTILATION

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.