Blind sampling techniques

Most ventilator-associated pneumonias are multifocal; hence blind sampling, which is cheaper and quicker, may be appropriate. Blind protected brushing can be performed in ventilated patients using a Metras catheter normally used for bronchography. In one study brushing directed by a fiber-optic bronchoscope had a sensitivity of 71 per cent whilst that from blind brushing was 64 per cent, with close agreement in the organisms cultured. Likewise, non-bronchoscopic bronchoalveolar lavage has a reported sensitivity of 75 per cent, even though 86 per cent of samples are right-sided. Patients are preoxygenated and briefly disconnected from the ventilator, and a 50-cm sterile plugged telescoping catheter (Combicath) is blindly inserted until wedged. The plug is expelled by injecting air and the inner catheter advanced at least 3 cm distally until wedged. Lavage is performed with 20 ml of saline and at least 1 ml is recovered for examination and culture.

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