* Bronchoalveolar lavage or protected specimen brush
with quantitative cultures
Bronchoscopy with bronchoalveolar lavage (BAL) or protected specimen brush (PSB) has shown advantages in the diagnosis of pneumonia in patients on mechanical ventilation .
To Bello 1996, the routine of bronchoscopic technique use, such as BAL and PSB (protected specimen brush), for example, is limited by various time-consuming and relatively expensive factors and because of the costs of the sampling brush and the need for a fiberoptic guide.
Diagnosis of ventilator-associated pneumonia: Focus on nonbronchoscopic techniques (nonbronchoscopic bronchoalveolar lavage, including mini-BAL, blinded protected specimen brush
, and blinded bronchial sampling) and endotracheal aspirates.
A study of stable and exacerbated outpatients using the protected specimen brush
. Am J Respir Crit Care Med 1995; 152:1316-1320.
To rule out infection, bronchoscopy and protected specimen brush were conducted.
On direct examination, a Gram stain of the protected specimen brush sample showed numerous gram-positive bacilli.
VAP is most accurately diagnosed by quantitative culture and microscopy examination of lower respiratory tract secretions, which are best obtained by bronchoscopically directed techniques such as the protected specimen brush
and bronchoalveolar lavage.