DIAGNOSIS OF NOSOCOMIAL PNEUMONIA IN MECHANICALLY VENTILATED PATIENTSBY THE BLIND PROTECTED TELESCOPING CATHETER

Objectives: To demonstrate that blind insertion of the protected teles coping catheter (PTC-NB) through the orotracheal tube can provide reli able pulmonary samples for the diagnosis of nosocomial pneumonia (NP) in ventilated patients. Design: We performed a random comparison betwe en the protected telescoping catheter intoduced through a bronchofiber scope (PTC-B) and the PTC-NB to diagnose NP. Setting: A general intens ive care unit of a University Hospital. Patients: 40 consecutive patie nts on mechanical ventilation and with suspicion of NP. The diagnosis of NP was suspected by clinical and chest X-ray findings. Measurements and results. NP was confirmed microbiologically in 26 (65%) patients and maintained in 8 patients by clinical and radiological criteria. PT C-NB confirmed the microbiological diagnosis of PN in 21 (80%) patient s. The use of antibiotics prior taking respiratory samples reduced the sensitivity of PTC-NB and PTC-B from 100-74% and from 94-70% (p=0.001 ). Both techniques agreed in 24 of 33 (73%) patients but such agreemen t was better when PN was on the right lung. Two patients developed a s elf-limiting hemoptysis after the PTC-B procedure. Conclusions: PTC-NB is as sensitive as specific as PTC-B for diagnosing PN in mechanicall y ventilated patients, being a much easier technique to use.