Skip to main content
SpringerLink
Log in

Fibrobronchoscopy as a Diagnostic Tool in Sepsis of Pulmonary Origin

  • Chapter
Sepsis

  • 118 Accesses

Abstract

Most patients with community-acquired pneumonia receive empiric antimicro­bial treatment without any intervention to look for the originating pathogen. However, community-acquired pneumonia is causing more than 500,000 hospi­talizations per year in the United States with a global mortality of 0.1%. The routine studies (hemoculture and sputum culture) have less sensitivity and, in fact, could generate confusion after being contaminated with nonpathogen germs in the upper airway. A similar situation occurs in hospitalized patients at inten­sive care units in which the appearance of new infiltrates should alert the physi­cian to look both for infectious diseases and for noninfectious ones, a differentiation that is not always easy to make. Patients’ characteristics, such as age, immune system function, and use of mechanical ventilation, are keys to determining the cause of the radiologic abnormality.2 When an infectious disease is suspected, it would be convenient to correlate it with a sample taken from the lower respiratory tract for microbiologic study with procedures whose advan­tages and disadvantages will be discussed below3,4 (Table 6.1).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bartlett JG, Breiman RF, Mandell LA, et al. Community-acquired pneumonia in adults: Guidelines for management. Clin Infect Dis 1998; 26: 811.

    Article  PubMed  CAS  Google Scholar 

  2. Lambotte O, Tonsit JF, Garrouste-Oregeas M,. The significance of distal bronchial samples with commensals in ventilator associated pneumonia. Chest 2002: 122; 138999.

    Google Scholar 

  3. Kirtland SH, Corley DE, Winterbauer RH, et al. The diagnosis of ventilator-associated pneumonia: A comparison of histologic, microbiologic, and clinical criteria. Chest 1997; 112: 445.

    Article  PubMed  CAS  Google Scholar 

  4. Liebler JM, Markin CJ. Fiberoptic bronchoscopy for diagnosis and treatment. Crit Care Clin 2000; 16: 1.

    Article  Google Scholar 

  5. G.A. Hincapie

    Google Scholar 

  6. Chastre J, Fagon J, Bornet-Lesco M, et al. Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med 1995; 152: 231.

    PubMed  CAS  Google Scholar 

  7. Rodriguez RM, Fancher ML, Phelps M, An emergency department-based randomized trial of nonbronchoscopic bronchoalveolar lavage for early pathogen identification in severe community-acquired pneumonia. Ann Emerg Med 2001; 38357–63.

    Google Scholar 

  8. Tai DY. Bronchoscopy in the intensive care unit (ICU). Ann Acad Med Singapore 1998; 27: 552–9.

    PubMed  CAS  Google Scholar 

  9. Baselski VS, Wunderink RG. Bronchoscopic diagnosis of pneumonia. Clin Microbiol Rev 1994; 7533–58.

    Google Scholar 

  10. Jimenez P, Saldias F, Meneses M, et al. Diagnostic fiberoptic bronchoscopy in patients with community-acquired pneumonia: Comparison between bronchoalveolar lavage and telescoping plugged catheter cultures. Chest 1993;1031023-7.

    Google Scholar 

  11. Jourdain B, Joly-Guillow ML, Dombret MC, et al. Usefulness of quantitative cultures of BAL fluid for diagnosing nosocomial pneumonia in ventilated patients. Chest 1997; 111: 411.

    Article  PubMed  CAS  Google Scholar 

  12. Stover DE, Zaman MB, Hajdu SI, et al. Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med 1984; 101: 1.

    PubMed  CAS  Google Scholar 

  13. Mares DC, Wilkes DS. Bronchoscopy in the diagnosis of respiratory infections. Curr Opin Pulm Med 1998; 4123–9.

    Google Scholar 

  14. Tobin MJ. Diagnosis of pneumonia: techniques and problems. Clin Chest Med 1987; 8: 513–27.

    PubMed  CAS  Google Scholar 

  15. Korsgaard J, Rasmussen TR, Sommer T, et al. Intensified microbiological investigations in adult patients admitted to hospital with lower respiratory tract infections. Respir Med 2002; 96: 344–51.

    Article  PubMed  CAS  Google Scholar 

  16. Delclaux C, Roupie E, Blot F, et al. Lower respiratory tract colonization and infection during severe acute respiratory distress syndrome: incidence and diagnosis. Am J Respir Crit Care Med 1997; 156: 1092–8.

    PubMed  CAS  Google Scholar 

  17. Bonten M, Bergmans D, Stobbering E, et al. Implementation of bronchoscopic techniques in the diagnosis of ventilator associated pneumonia to reduce antibiotic use. Am Respir Crit Care Med 1997; 156: 1820–4.

    CAS  Google Scholar 

  18. British Thoracic Society Bronchoscopy Guidelines Committee. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax 2001; 56: S1–S31.

    Google Scholar 

  19. Meduri U, Reddy R, Stanley T, et al. Pneumonia in acute respiratory distress syndrome. Am J Respir Crit Care Med 1998; 158: 870–5.

    PubMed  CAS  Google Scholar 

  20. Heyland DK, Cook DJ, Marshall J, et al. The clinical utility of invasive diagnostic techniques in the setting of ventilator-associated pneumonia. Chest 1999; 115: 107684.

    Google Scholar 

  21. Chastre J, Viau F, Brun P, et al. Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated patients. Am Rev Respir Dis 1984; 130: 924.

    PubMed  CAS  Google Scholar 

  22. Pereira JC, Pedreira W, Araujo E, et al. Impact of BAL in the management of pneumonia with treatment failure. Chest 2000; 118: 1739–46.

    Article  Google Scholar 

  23. Niederman M. Bronchoscopy in nonresolving nosocomial pneumonia. Chest 2000; 117: 212S–8S.

    Article  PubMed  CAS  Google Scholar 

  24. Sorensen J, Forsberg P, Hakanson E, A new diagnostic approach to the patient with severe pneumonia. Scand J Infect Dis 1989; 21: 33–41.

    Article  PubMed  CAS  Google Scholar 

  25. Ewig S, Torres A. Flexible bronchoscopy in nosocomial pneumonia. In: Mehta A. Flexible bronchoscopy. Clin Chest Med 2001; 22: 263–79.

    Google Scholar 

  26. Hincapié G. Fibrobroncoscopia en paciente en estado critico. In: Dueflas C, Ortiz G, Gonzalez MA, Ventilación Mecanica; Aplicación en el paciente crítico. Bogota: Distribuna, 2003: 81–6.

    Google Scholar 

  27. Froon AH, Bonten MJ, Gaillard CA, et al. Prediction of clinical severity and outcome of ventilator-associated pneumonia. Comparison of simplified acute physiology score with systemic inflammatory mediators. Am J Respir Crit Care Med 1998; 158: 10 2631.

    Google Scholar 

  28. Hilbert G, Gruson D, Vargas F, et al. Bronchoscopy with bronchoalveolar lavage via the laryngeal mask airway in high-risk hypoxemic immunosuppressed patients. Crit Care Med 2001; 29: 249–55.

    Article  PubMed  CAS  Google Scholar 

  29. Wunderink R, Leeper K Jr, Schein R, et al. Filgrastim in patients with pneumonia and severe sepsis or septic shock. Chest 2001;119523-9.

    Google Scholar 

  30. Garfein ES, Ginsberg ME, Gorenstein L, et al. Superiority of end-to-end versus telescoped bronchial anastomosis in single lung transplantation for pulmonary emphysema. J Thorac Cardiovasc Surg 2001; 121: 149–54.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Gustavo Adolfo Hincapie
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Universidad del Bosque, Bogotá, Colombia

    Guillermo Ortiz-Ruiz MD (Professor of Pulmonary and Critical Care Medicine) (Professor of Pulmonary and Critical Care Medicine)

  2. Fundacion Clinica Shaio, Bogotá, Colombia

    Marco A. Perafán MD (Professor of Cardiology and Critical Care Medicine) (Professor of Cardiology and Critical Care Medicine)

  3. Department of Surgery, Klinikum Grosshadern, University of Munich, Munich, Germany

    Eugen Faist MD (Professor) (Professor)

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer Science+Business Media New York

About this chapter

Cite this chapter

Hincapie, G.A. (2004). Fibrobronchoscopy as a Diagnostic Tool in Sepsis of Pulmonary Origin. In: Ortiz-Ruiz, G., Perafán, M.A., Faist, E. (eds) Sepsis. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3824-7_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4757-3824-7_6

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-20451-2

  • Online ISBN: 978-1-4757-3824-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation