Olcay YAKA, BAŞAK CEYDA MEÇO, Melek TULUNAY

VENTİLATÖR İLİŞKİLİ PNÖMONİDE KANTİTATİF TRAKEAL ASPİRAT KÜLTÜRÜ İLE KÖR BRONKOALVEOLER LAVAJ KÜLTÜRÜNÜN TANISAL UYUMU

Amaç: Yoğun bakım ünitelerinde (YBÜ) tedavi edilen ve mekanik ventilatör desteği altında olan kritik hastalar ventilatör ilişkili pnömoniler (VİP) açısından risk altındadırlar. VİP gelişen hastalar yüksek mortalite oranlarına sahiptirler. Ancak VİP’lerin mikrobiyolojik tanısında gerçek bir altın standart tanısal yöntem yoktur. Bu prospektif çalışmanın birincil amacı, YBÜ’de VİP şüphesi olan kritik hastalarda iki nonbronkoskopik örnekleme yöntemi olan endotrakeal aspirat (ETA) ile kör mini bronkoalveoler lavajın (KM-BAL) mikrobiyolojik sonuçlarının ve birbirleri ile olan uyumlarının saptanmasıdır. Çalışmanın ikincil amacı ise KM-BALyönteminin uygulanmasına ilişkin özelliklerin değerlendirilmesidir (kateterin mesafesi, BALilişkili komplikasyonlar). Yöntem: Bu çalışmaya, Etik Kurul onayı alındıktan sonra Nisan 2011 ve Eylül 2011 tarihleri arasında VİP şüphesi olan toplam 37 hasta dahil edildi ve KM-BAL ve ETA örneklemeleri yapıldı, hastaların laboratuvar parametreleri ve YBÜ skorlamaları kaydedildi. Bulgular: İki yöntemin uyumluluğuna bakıldığında aralarındaki uyum kabul edilebilir düzeydeydi. Endotrakeal aspirat ve KM-BAL kültürlerinde üreme olan hastaların kültür sonuçlarının raporlanma saatine bakıldığında BAL kültürlerinin istatistiksel olarak anlamlı şekilde daha erken sonuç verdiği tespit edildi (p=0,05). Hastalarda KM-BAL kateterinin akciğerlerde gittiği lokalizasyon değerlendirildiğinde infiltrasyon alanına yönlenmenin zor olduğu ancak bu durumun kültürlerdeki üremeleri etkilemediği gözlendi. Sonuç: VİP tanısında kullanılan kör BAL kültürü tekniği ucuz, kolay uygulanabilen, az komplikasyona sahip olan bir yöntem olmasına rağmen, infiltrasyon alanından örnek almak her zaman mümkün olmamaktadır. Ventilatör ilişkili pnömoni tanısında yıllardır kullanılan trakeal aspirat kültürü de kör BAL ile uyumlu gözükmektedir.

DIAGNOSTIC EFFICACY OF QUANTIVE ENDOTRACHEAL ASPIRATE AND BLIND BRONCHOALVEOLAR LAVAGE CULTURES IN VENTILATORY INDUCED PENUMONIA

Objective: Mechanically ventilated critically ill intensive care unit (ICU) patients are under risk for ventilatory induced pneumonia (VIP). Ventilatory induced pneumonia has high mortality. It has been concluded that difficult intubation via LMA-FT can be predicted by initially doing a fiberoptic bronchoscopic evaluation. The primary aim of this prospective study was to compare the microbiological results and define the concordance of blind bronchoalveolar lavage (BAL) with endotracheal aspirates (ETA) in critically ill intensive care unit patients with ventilatory induced pneumonia. The secondary aim of the study was to evaluate the characteristics (distance of the catheter, BALrelated complications) related to this technique. Method: After Ethical Committee approval, 37 patients with suspected VIP were admitted to the study between April 2011-September 2011. BALand ETAsamples were collected, and ICU scores and laboratory parameters were recorded. Results: When the two sampling methods were compared (BAL with ETA), microbiological results were in concordance with each other. The result reporting times were also recorded and BAL results were significantly reported earlier than ETA results (p=0,05). In addition, the localizations of the BAL catheter in the lung fields were assessed. Although it was difficult to perform the sampling from the infiltration side, this did not influence the culture results. Conclusion: The blind BALtechnique is a non-expensive and easy method with low complication rates. However it is not always easy to obtain the sampling from the infiltration side. Tracheal aspirate, which is frequently used for the diagnosis of VIP since so many years, is in concordance with BAL.

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