Comparison of Bronchoscopic and Nonbronchoscopic Methods of Airway Culturing in Tracheostomized Children.

Introduction: Distal airway secretions can be sampled by bronchoscopic bronchoalveolar lavage (B-BAL), blind protected BAL (BP-BAL) and tracheal aspirates (TA). We quantitatively compared the cultures of distal airway secretions from BP-BAL, B-BAL, and TA and assessed the efficacy of the three above methods in diagnosing bronchitis in tracheostomized children.

Method: Twenty children with tracheostomies underwent BP-BAL, B-BAL and TA. Samples were sent for quantitative bacterial cultures. Diagnosis of bronchitis was made based on a validated visual grading system as well as on positive quantitative culture in the BAL fluid. Diagnostic agreement between cultures obtained by the three methods and the visual grading scores was determined by kappa statistics.

Results: Diagnosis of bronchitis by visual grading score had substantial agreement with BP-BAL, moderate agreement with B-BAL, and fair agreement with TA. BP-BAL had significantly lower pathogenic colonies (P<0.05) than either B-BAL or TA.

Conclusion: BP-BAL allows for more accurate sampling of lower airway secretions in tracheostomized children and is more accurate in the diagnosis of bronchitis in this group.