Usefulness of quantitative cultures of BAL fluid for diagnosing nosocomial pneumonia in ventilated patients.

Abstract:

STUDY OBJECTIVE:To evaluate the role of quantitative cultures of BAL for diagnosing nosocomial pneumonia in mechanically ventilated patients. DESIGN:Cohort study. SETTING:Medical ICU, Hôpital Bichat, Paris, France, an academic tertiary care center. PATIENTS:A total of 141 episodes of suspected lung infection in 84 consecutive patients mechanically ventilated for 48 h or more. MEASUREMENTS AND RESULTS:Microbiologic findings obtained using BAL were compared with those obtained with protected specimen brush (PSB) samples and their operating characteristics were determined. The level of qualitative agreement between BAL and PSB specimen cultures was high, with 83% of the organisms isolated in PSB specimens being recovered simultaneously from BAL fluid. In addition, the results of quantitative BAL and PSB cultures were significantly correlated (rho = 0.46, p < 0.0001). Fifty-seven cases of pneumonia were diagnosed based on the following criteria: PSB sample yielding > or = 10(3) cfu/mL of at least one microorganism and/or > or = 5% of cells containing intracellular bacteria on direct examination of BAL. The operating characteristics of BAL fluid cultures were determined using different ways to report the results and over a range of values. The discriminative value of 10(4) cfu/mL was found to be an optimal threshold, with a sensitivity of 82% (95% confidence interval [CI], 76 to 88) and a specificity of 84.5% (95% CI, 79 to 90). CONCLUSIONS:These results indicate that BAL fluid cultures can offer a sensitive and specific means to diagnose pneumonia in ventilated patients and may provide relevant information about the causative pathogens.

journal_name

Chest

journal_title

Chest

authors

Jourdain B,Joly-Guillou ML,Dombret MC,Calvat S,Trouillet JL,Gibert C,Chastre J

doi

10.1378/chest.111.2.411

subject

Has Abstract

pub_date

1997-02-01 00:00:00

pages

411-8

issue

2

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(15)52542-7

journal_volume

111

pub_type

杂志文章

相关文献

CHEST文献大全
  • Screening of pediatric sleep-disordered breathing: a proposed unbiased discriminative set of questions using clinical severity scales.

    abstract:BACKGROUND:Identification of sleep-disordered breathing (SDB) using questionnaires is critical from a clinical and research perspective. However, which questions to use and how well such questionnaires perform has thus far been fraught with substantial uncertainty. We aimed at delineating the usefulness of a set of que...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.11-3164

    authors: Spruyt K,Gozal D

    更新日期:2012-12-01 00:00:00

  • Distal airway function in symptomatic subjects with normal spirometry following World Trade Center dust exposure.

    abstract:RATIONALE:Following collapse of the World Trade Center (WTC), individuals reported new-onset respiratory symptoms. Despite symptoms, spirometry often revealed normal airway function. However, bronchial wall thickening and air trapping were seen radiographically in some subjects. We hypothesized that symptomatic individ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.07-0913

    authors: Oppenheimer BW,Goldring RM,Herberg ME,Hofer IS,Reyfman PA,Liautaud S,Rom WN,Reibman J,Berger KI

    更新日期:2007-10-01 00:00:00

  • Coronary artery spasm complicating anaphylaxis secondary to skin disinfectant.

    abstract::We report a patient in whom presumed vasospasm of an angiographically normal coronary artery led to severe transmural myocardial ischemia. To our knowledge, this is the first case in which an allergic reaction to locally applied chlorhexidine caused such a severe reaction. ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.113.5.1417

    authors: Conraads VM,Jorens PG,Ebo DG,Claeys MJ,Bosmans JM,Vrints CJ

    更新日期:1998-05-01 00:00:00

  • Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study.

    abstract:BACKGROUND:The aim of this prospective, multicenter study was to define the accuracy of lung ultrasound (LUS) in the diagnosis of community-acquired pneumonia (CAP). METHODS:Three hundred sixty-two patients with suspected CAP were enrolled in 14 European centers. At baseline, history, clinical examination, laboratory ...

    journal_title:Chest

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1378/chest.12-0364

    authors: Reissig A,Copetti R,Mathis G,Mempel C,Schuler A,Zechner P,Aliberti S,Neumann R,Kroegel C,Hoyer H

    更新日期:2012-10-01 00:00:00

  • A comparison of albuterol administered by metered-dose inhaler and spacer with albuterol by nebulizer in adults presenting to an urban emergency department with acute asthma.

    abstract:STUDY OBJECTIVES:To determine the efficacy of albuterol by metered-dose inhaler (MDI) and spacer compared to a nebulizer. DESIGN:A prospective, open-label study. SETTING:Large urban emergency department (ED). PATIENTS:All consecutive adult asthma patients over a 2.5-year period. INTERVENTIONS:ED personnel used a st...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.121.4.1036

    authors: Newman KB,Milne S,Hamilton C,Hall K

    更新日期:2002-04-01 00:00:00

  • Continuous monitoring of mixed venous oxygen saturation in patients with acute myocardial infarction.

    abstract::Continuous measurement of mixed venous oxygen saturation (SvO2) has been suggested as an adjunct in monitoring critically ill patients. We evaluated SvO2 monitoring in 24 patients suffering from complicated myocardial infarctions. Cardiac output and arterial lactate levels were measured when there were persistent 5 pe...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.95.3.607

    authors: Kyff JV,Vaughn S,Yang SC,Raheja R,Puri VK

    更新日期:1989-03-01 00:00:00

  • Symptomatic coccidioidomycosis following a severe natural dust storm. An outbreak at the Naval Air Station, Lemoore, Calif.

    abstract::Eighteen newly diagnosed cases of symptomatic cocidioidomycosis developed two to four weeks following exposure to a severe natural dust storm. The population at risk consisted of 26,000 residents of the San Joaquin Valley with access to health care at the Naval Hospital, Lemoore, Calif. Eight patients were white, and ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.76.5.566

    authors: Williams PL,Sable DL,Mendez P,Smyth LT

    更新日期:1979-11-01 00:00:00

  • Female asthmatics have increased hypercapnic chemosensitivity during the luteal phase which is not associated with decline in airway function.

    abstract::To examine whether changes in respiratory chemosensitivity during the menstrual cycle are related to worsening of airway functions, hypoxic and hypercapnic ventilatory and P0.1 responses, airway function, and serum progesterone levels were studied in 11 female asthmatic patients in both the follicular and luteal phase...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.104.6.1718

    authors: Munakata M,Yamamoto H,Akiyama Y,Inaba S,Kawakami Y

    更新日期:1993-12-01 00:00:00

  • Correlation of leukocyte esterase detection by reagent strips and the presence of neutrophils: a study in BAL fluid.

    abstract:STUDY OBJECTIVE:In the present study, we evaluated the leukocyte esterase (LE) area of a reagent strip designed for urinalysis for the semiquantitative measurement of the percentage of polymorphonuclear neutrophils (PMNs) in BAL fluid. DESIGN:Prospective. The relative PMN counts (obtained by conventional microscopy an...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.118.5.1450

    authors: Jacobs JA,De Brauwer EI,Cornelissen EI,Drent M

    更新日期:2000-11-01 00:00:00

  • Treatment of stage IIIA non-small cell lung cancer.

    abstract::Stage IIIA non-small cell lung cancer represents a relatively heterogeneous group of patients with metastatic disease to the ipsilateral mediastinal (N2) lymph nodes and also includes T3N1 patients. Presentations of disease range from apparently resectable tumors with occult microscopic nodal metastases to unresectabl...

    journal_title:Chest

    pub_type: 指南,杂志文章,实务指引,评审

    doi:10.1378/chest.123.1_suppl.202s

    authors: Robinson LA,Wagner H Jr,Ruckdeschel JC,American College of Chest Physicians.

    更新日期:2003-01-01 00:00:00

  • Specific expiratory muscle training in COPD.

    abstract:BACKGROUND:There are several reports showing that expiratory muscle strength and endurance can be impaired in patients with COPD. This muscle weakness may have clinically relevant implications. Expiratory muscle training tended to improve cough and to reduce the sensation of respiratory effort during exercise in patien...

    journal_title:Chest

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1378/chest.124.2.468

    authors: Weiner P,Magadle R,Beckerman M,Weiner M,Berar-Yanay N

    更新日期:2003-08-01 00:00:00

  • Further observations on the electrophysiologic effects of oral amiodarone therapy.

    abstract::A case is presented of a reversible intra-Hisian block occurring under amiodarone treatment for atrial tachycardia in a patient without clear intraventricular conduction abnormalities. His bundle recordings showed an atrial tachycardia with intermittent exit block and greatly prolonged BH and HV intervals (40 and 100 ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.82.1.117

    authors: Santinelli V,Chiariello M,Ambrosio G,Stanislao M,Condorelli M

    更新日期:1982-07-01 00:00:00

  • Feasibility of intraoperative cytodiagnosis of lung cancer.

    abstract::Of 354 thoracotomies, 114 cases involved intraoperative cytopathologic evaluation. The study included 86 men and 28 women, and 184 specimens were examined. Smears were taken from the lung lesion or lymph node and the chest wall or bronchial stump by imprint or needle aspiration. Intraoperative evaluations were compare...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.98.5.1156

    authors: Terada Y,Matsunobe S,Nemoto T,Tsuda T,Shimizu Y

    更新日期:1990-11-01 00:00:00

  • Decreased Serum Sirtuin-1 in COPD.

    abstract:BACKGROUND:The protein deacetylase sirtuin-1 (SIRT1) is an antiaging molecule that is decreased in the lung in patients with COPD. Recently, SIRT1 was reported to be detectable in serum, but serum SIRT1 (s120S) levels have not yet been reported in patients with COPD. METHODS:Serum SIRT1 protein of all samples was meas...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1016/j.chest.2017.05.004

    authors: Yanagisawa S,Papaioannou AI,Papaporfyriou A,Baker JR,Vuppusetty C,Loukides S,Barnes PJ,Ito K

    更新日期:2017-08-01 00:00:00

  • Oxidant-antioxidant balance in granulocytes during ARDS. Effect of N-acetylcysteine.

    abstract::The production of cytotoxic oxygen radicals by activated granulocytes is a proposed mechanism of lung injury in ARDS. Protective effects of N-acetylcysteine (NAC) have been described in experimental and clinical ARDS. NAC could act in part by replenishing the intracellular stores of glutathione (GSH) in activated gran...

    journal_title:Chest

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1378/chest.109.1.163

    authors: Laurent T,Markert M,Feihl F,Schaller MD,Perret C

    更新日期:1996-01-01 00:00:00

  • Dynamic expiratory tracheal collapse in COPD: correlation with clinical and physiologic parameters.

    abstract:BACKGROUND:COPD has been described as a risk factor for excessive expiratory tracheal collapse, but its prevalence and clinical correlates have not been fully determined. The purpose of this study is to prospectively determine the prevalence of excessive expiratory tracheal collapse among patients with COPD and to test...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.12-0299

    authors: Boiselle PM,Michaud G,Roberts DH,Loring SH,Womble HM,Millett ME,O'Donnell CR

    更新日期:2012-12-01 00:00:00

  • Stability of blood gases in ice and at room temperature.

    abstract::Arterial blood samples from 75 patients were analyzed for PO2, PCO2, and pH at 0, 15, and 30 min. After the baseline analysis, 60 samples were kept in ice while 59 samples were left at room temperature. There was a statistically significant increase in the PO2 at 15 min and again at 30 min in both groups. There was a ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.103.4.1120

    authors: Liss HP,Payne CP Jr

    更新日期:1993-04-01 00:00:00

  • AIDS and malignant mesothelioma--is there a connection?

    abstract::A 35-year-old male homosexual, a former intravenous drug abuser, was found to be human immunodeficiency virus (HIV) positive in 1984. He developed AIDS in 1987 and began treatment with zidovudine in 1989. One year later he developed left apical pleural blebs, a pneumothorax and an exudative pleural effusion. A maligna...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.103.4.1268

    authors: Behling CA,Wolf PL,Haghighi P

    更新日期:1993-04-01 00:00:00

  • The relationship between the components of pulmonary artery pressure remains constant under all conditions in both health and disease.

    abstract:BACKGROUND:The relationships among systolic pulmonary artery pressure (SPAP), diastolic pulmonary artery pressure (DPAP), and mean pulmonary artery pressure (MPAP) have been found to be constant in humans breathing air, at rest, while supine. It would be important for those studying the pulmonary circulation if this re...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.07-1367

    authors: Syyed R,Reeves JT,Welsh D,Raeside D,Johnson MK,Peacock AJ

    更新日期:2008-03-01 00:00:00

  • Perioperative predictors of acute cholecystitis after cardiovascular surgery.

    abstract:OBJECTIVE:To determine the incidence, diagnostic features, and perioperative predictors of acute cholecystitis after cardiovascular surgery. DESIGN:Inception cohort study. SETTING:A tertiary care 54-bed cardiothoracic ICU. PATIENTS:All patients admitted to an ICU after cardiovascular surgery during a 42-month period...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.114.1.76

    authors: Rady MY,Kodavatiganti R,Ryan T

    更新日期:1998-07-01 00:00:00

  • Mass ammonia inhalation.

    abstract::The clinical, roentgenographic and laboratory findings, their relationship to each other and to the subsequent hospital course are reported for 14 victims of gaseous ammonia inhalation. Initial physical examination enabled differentiation of a mildly affected from a moderately affected group, but patients in both grou...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.77.4.496

    authors: Montague TJ,Macneil AR

    更新日期:1980-04-01 00:00:00

  • Early post-pneumonectomy bronchial stump fistula.

    abstract::Bronchial stump fistula occurred on the seventh postoperative day in a 45-year-old man who underwent right pneumonectomy for T2N2M0 adenocarcinoma of the lung. It was attributable to ventilator-related barotrauma during treatment of ARDS from multiple pulmonary emboli. A frequently lethal complication, its presentatio...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.93.3.654

    authors: Pomerantz AH,Derasari MD,Sethi SS,Khan S

    更新日期:1988-03-01 00:00:00

  • Combined aortic and mitral valve replacement in an adult with Scheie's disease.

    abstract::Mitral, aortic, and coronary arterial disease have been described in the various mucopolysaccharidoses. We report the first successful combined aortic and mitral valve replacement in an adult female patient with severe aortic and mitral stenosis due to Scheie's syndrome, a mucopolysaccharide storage disease. Both annu...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.96.1.209

    authors: Butman SM,Karl L,Copeland JG

    更新日期:1989-07-01 00:00:00

  • Aortopulmonary window or aortopulmonary communication?

    abstract::Two patients had a vessel-like aortopulmonary "window" which could be ligated without the institution of cardiopulmonary bypass. While embryologically and functionally these communications are identical to the classic aortopulmonary "window," it is suggested that the term "aortopulmonary communication" is more appropr...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.75.3.397

    authors: Belcourt CL,Aterman K,Gillis DA,Roy DL

    更新日期:1979-03-01 00:00:00

  • Effect of thoracentesis on respiratory mechanics and gas exchange in the patient receiving mechanical ventilation.

    abstract:BACKGROUND:This study reports the effect of thoracentesis on respiratory mechanics and gas exchange in patients receiving mechanical ventilation. STUDY DESIGN:Prospective. SETTING:University hospital. PATIENTS:Eight patient receiving mechanical ventilation with unilateral (n = 7) or bilateral (n = 1) large pleural e...

    journal_title:Chest

    pub_type: 临床试验,杂志文章

    doi:10.1378/chest.130.5.1354

    authors: Doelken P,Abreu R,Sahn SA,Mayo PH

    更新日期:2006-11-01 00:00:00

  • Effect of 30 mg of morphine alone or with promethazine or prochlorperazine on the exercise capacity of patients with COPD.

    abstract:OBJECTIVE:We have shown that the administration of 0.8 mg/kg of morphine (M) to patients with COPD resulted in a 20% increase in the maximum oxygen consumption (Vo2max), but was associated with significant drowsiness and euphoria. The objective of the present study was to ascertain whether lower doses of M alone or in ...

    journal_title:Chest

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1378/chest.109.4.975

    authors: Light RW,Stansbury DW,Webster JS

    更新日期:1996-04-01 00:00:00

  • Underreading of the tuberculin skin test reaction.

    abstract:STUDY OBJECTIVE:The tuberculin skin test is the best diagnostic method to detect tuberculous infection. How accurate is interpretation of the test? DESIGN:Observational study. SETTING:Both general hospital and university hospital. PARTICIPANTS:One hundred seven health-care professionals, including 52 practicing pedi...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.113.5.1175

    authors: Kendig EL Jr,Kirkpatrick BV,Carter WH,Hill FA,Caldwell K,Entwistle M

    更新日期:1998-05-01 00:00:00

  • Hypertrophic obstructive cardiomyopathy and coronary artery spasm.

    abstract::Three patients had hypertrophic obstructive cardiomyopathy and coronary artery spasm. The clinical diagnosis of hypertrophic obstructive cardiomyopathy, in all patients, was confirmed by echocardiography and angiography. Significant spasm of the right coronary artery was demonstrated in each patient by selective coron...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.76.6.636

    authors: Mautner RK,Thomas I,Dhurandhar R,Phillips JH

    更新日期:1979-12-01 00:00:00

  • Respiratory muscle training for respiratory deficits in neurodegenerative disorders: a systematic review.

    abstract:BACKGROUND:Studies of the impact of respiratory muscle training (RMT) on central neurodegenerative pathologies have been aimed at improving pulmonary function. However, there is no certainty about the effectiveness of RMT in patients affected by these groups of disorders. The purpose of this review was to assess the ev...

    journal_title:Chest

    pub_type: 杂志文章,评审

    doi:10.1378/chest.12-1442

    authors: Reyes A,Ziman M,Nosaka K

    更新日期:2013-05-01 00:00:00

  • Impact of habitual cocaine smoking on the physiologic response to maximum exercise.

    abstract:BACKGROUND:Habitual smoking of alkaloidal cocaine (crack) has been reported to be associated with a number of cardiopulmonary complications that may not be clinically obvious but could potentially interfere with normal physiologic responses to exercise and thus impair maximum exercise performance. STUDY OBJECTIVE:To e...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.112.4.1008

    authors: Marques-Magallanes JA,Koyal SN,Cooper CB,Kleerup EC,Tashkin DP

    更新日期:1997-10-01 00:00:00