Conclusions

Results from both bronchoalveolar lavage and brushings are sufficiently variable, even in experienced hands, for them to be regarded as investigational tools only. Where there is close liaison between the microbiology department and the intensive care unit, these techniques will be useful. They require further evaluation with regard to both their applicability in different subgroups and their effect on survival.

Many physicians will continue to manage patients on the basis of clinical findings and microbiological cultures obtained non-invasively. This remains appropriate until invasive diagnostic sampling with quantitative cultures has been shown to produce a definite improvement in outcome.

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