Comparison between bronchoscopic BAL and non-bronchoscopic BAL in patients with VAP

Background: The diagnosis of ventilator associated pneumonia (VAP) remains a challenge because the clinical signs and symptoms lack both sensitivity and specificity and the selection of microbiologic diagnostic procedure is still a matter of debate. Objective: To compare the diagnostic value of bronchoscopic BAL and non-bronchoscopic protected BAL in patients with VAP. Materials and methods: Twenty patients, clinically diagnosed with VAP, were involved in this research; they were evaluated by bronchoscopic and non-bronchoscopic BAL for diagnosis of VAP. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of bronchoscopic and non-bronchoscopic BAL were calculated, taking clinical pulmonary infection score (CPIS) of ⩾6 as reference standard. Results: There was a good microbiologic concordance and strong correlation between bronchoscopic BAL and non bronchoscopic BAL in diagnosis of VAP. There was a high concordance between CPIS score and both procedures’ results. Percentage of concordance between CPIS and bronchoscopic BAL was 97.5% and with non bronchoscopic BAL was 95%. Gram negative organisms were the commonest organisms isolated by both techniques. Conclusion: Non bronchoscopic BAL is an inexpensive, easy, and useful technique for microbiologic diagnosis of VAP. This finding, if verified, might simplify the approach for the diagnosis of VAP.