PT - JOURNAL ARTICLE 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 TI - Evaluation of Blind Nasotracheal Suctioning and Non-bronchoscopic Mini-Bronchoalveolar Lavage in Critically Ill Patients with Infectious Pneumonia: A Preliminary Study AID - 10.4187/respcare.02356 DP - 2014 Mar 01 TA - Respiratory Care PG - 345--352 VI - 59 IP - 3 4099 - http://rc.rcjournal.com/content/59/3/345.short 4100 - http://rc.rcjournal.com/content/59/3/345.full AB - BACKGROUND: We evaluated the diagnostic performance and safety of combined blind nasotracheal suctioning and non-bronchoscopic mini-bronchoalveolar lavage (mini-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, nasotracheal suctioning, and mini-BAL via a double telescopic catheter (Combicath). Under local anesthesia, nasotracheal suctioning was done according to standard recommendations. Then mini-BAL was performed; the bronchial catheter serves as a guide for the mini-BAL catheter, and tracheal position is verified via colorimetric capnography. RESULTS: We included 36 subjects (29 men, median age 69 y, median Simplified Acute Physiology Score II 32), of which 32 (89%) underwent nasotracheal suctioning and mini-BAL, and from 13 (36%) we collected 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%) subjects, among whom 21 (88%) had undergone successful nasotracheal suctioning and mini-BAL, respectively, for 8/21 (38% [95% CI 0.17–0.58%] and 14/21 (67% [95% CI 0.46–0.86%]). Mini-BAL diagnosed a significantly higher percentage of bacterial pneumonias than did nasotracheal suctioning. Expectorated sputum yielded no diagnoses. CONCLUSIONS: Blind nasotracheal suctioning confirmed via colorimetric capnography allows microbiological diagnosis, and can be enhanced by non-bronchoscopic mini-BAL. Colorimetric capnography helps confirm bronchial tube position. Non-bronchoscopic mini-BAL is a novel and feasible way to collect bronchial secretions without fibroscopy. (ClinicalTrials.gov NCT00763620.)