TY - JOUR T1 - Evaluation of Blind Nasotracheal Suctioning and Non bronchoscopic Mini-Bronchoalveolar Lavage in Critically Ill Patients with Infectious Pneumonia: A Preliminary Study JF - Respiratory Care DO - 10.4187/respcare.02356 SP - respcare.02356 AU - Pascal Meyer AU - Hélène Rousseau AU - Jean-Michel Maillet AU - Stéphane Thierry AU - Oumar Sy AU - Eric Vicaut AU - Fabrice Thiolliere AU - Gerald Choukroun AU - Karim Chergui AU - Guillaume Chevrel AU - Eric Maury Y1 - 2013/07/23 UR - http://rc.rcjournal.com/content/early/2013/07/16/respcare.02356.abstract N2 - BACKGROUND: We evaluated the diagnostic performance and safety of combined blind nasotracheal suctioning (NTS) and non-bronchoscopic mini-bronchoalveolar lavage (BAL) to obtain respiratory secretion specimens from spontaneously breathing, non-intubated patients with infectious pneumonia in intensive care. METHODS: Patients suspected of having infectious pneumonia were included prospectively. Three samples were obtained: expectorated sputum, and NTS and mini-BAL with a double telescopic catheter (Combicath®). After administering local anesthesia, NTS was done according to standard recommendations. Then, mini-BAL was performed; the bronchial aspiration tube serves as a guide for the mini-BAL catheter, with tracheal position being verified by colorimetric capnography. RESULTS: Thirty-six patients (29 men, median age 69 years, median Simplified Acute Physiology Score II 32) were included. Thirty-two (89%) underwent NTS and mini-BAL; 13 (36%) had expectorated sputum. Based on colorimetric capnography confirmation of the tracheal position, 75% (24 /32) of the successful combined procedures were achieved on the first attempt. The median duration of the combined procedure was 7 min. Bacterial pneumonia was diagnosed in 24/36 (67%) patients, among whom, 21 (88%) had undergone NTS and mini-BAL, successful respectively, for 8/21 (38% [confidence interval 0.17–0.58] and 14/21 (67% [confidence interval 0.46–0.86]). Mini-BAL diagnosed a significantly higher percentage of bacterial pneumonias than NTS. Expectorated sputum yielded no diagnoses. CONCLUSIONS: Blind NTS associated with colorimetric capnography allows microbiological diagnosis that can be enhanced by non-bronchoscopic mini-BAL. It is probably useful to consider colorimetric capnography when the anatomical bronchial tube position is clinically doubtful. Non-bronchoscopic mini-BAL is a new and innovative way to collect bronchial secretions without fibroscopy. The results of our preliminary study demonstrated the feasibility of this procedure. ER -