Comparison of Bronchoalveolar Lavage, Mini Bronchoalveolar Lavage and ET aspirate in diagnosis and management of pneumonia in Intensive Care Unit

Abstract

Introduction- One of the main causes of morbidity and death for patients hospitalized to the intensive care unit is pneumonia. In these patients, bronchoalveolar lavage (BAL) is frequently utilized to aid in the diagnosis and characterization of pneumonia. Compared to BAL, mini-BAL and ETA are less intrusive, expensive, and time-consuming diagnostic tools. The present study
was conducted to compare microbiological examination of aspirate, taken by fiberoptic bronchoscope, mini-bal and et-aspirate from patients with diagnosis of pneumonia in intensive care unit.
Material & methods- The prospective study was conducted at department of pulmonary and critical care medicine, Shatabdi hospital, KGMU Lucknow for a period of 7 months among 59 intubated patients with diagnosis of pneumonia admitted in ICU.
Aspiration was done through BAL, mini BAL and ETA. Data were stored in the microsoft excel software (2010) and analysed through SPSS 22nd version.
Results- The mean age of patients was 57.0±13.2 years. Out of 59 patients 57.6% were male and 42.3% were females. Of BAL samples, bacteria were isolated in 14 (23.7%) and fungi were isolated in 21 (35.5 %). Of mini-BAL samples, bacteria were isolated in 15 (25.4%) and fungi were isolated in 17 (28.8%) and in ETA sample bacteria were isolated in 11 (18.6%) and fungi
were isolated in 11 (18.6%). Strong correlations for bacterial and fungal detection between BAL and mini-BAL (r = 0.830 and r
= 0.820, respectively).
Conclusion- The isolation rates of fungus and bacteria in BAL and mini-BAL samples were shown to be strongly correlated. The data clearly favors the use of mini-BAL sample as a less intrusive, more affordable, and easier option to traditional BAL sampling in these patients but it is not a definitive method of approach.