Am. J. Respir. Crit. Care Med., Vol 157, No. 1, 01 1998, 76-80.
Diagnosis of nosocomial pneumonia in mechanically ventilated patients: repeatability of the bronchoalveolar lavage [In Process Citation]
P Gerbeaux, V Ledoray, A Boussuges, F Molenat, P Jean and JM Sainty
Service de Reanimation Medicale, Hopital Salvator, CHRU Marseille, France.
The repeatability of the bronchoalveolar lavage (BAL) was assessed
prospectively in 44 mechanically ventilated patients with suspected
nosocomial pneumonia. Two BAL were performed in the same lung area
(contiguous segment) during two fibroscopic procedures performed with a
thirty minute interval. All the bronchoscopies were performed by the same
operator. The statistical analysis looked out for bias (MacNemar test),
agreement, and repeatability (kappa test). In the 44 patients studied, the
qualitative repeatability (i.e., presence or absence of bacteria) was
excellent (95.4%). However, in the 16 patients having at least one positive
culture, these results were more controversial. The quantitative
repeatability for bacteria (same log10 for both BAL of the same patient)
was the lowest of all the results (26.7%). The distinction between presence
and absence of bacterial pneumonia (based on the 10[4] cfu/ml threshold)
showed a repeatability of 75% with no bias, an agreement of 47% and a
just-significant kappa test (test = 1.97; p = 1.96 for a 5% risk error).
BAL seems to have excellent repeatability when sterile. Its repeatability
when positive needs further studies to be assessed.
