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correspondence

Indian Pediatr 2012;49: 420

Diagnosis of Ventilator-associated Pneumonia: Safety First

Banani Poddar

Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences,
Lucknow 226 014, India.
Email: [email protected]

 


The article entitled ‘Clinical Pulmonary Infection Score to diagnose ventilator-associated pneumonia in children’ makes interesting reading [1].

A variety of sampling techniques can be used to obtain a bronchial sample for culture and it is not always necessary to use a bronchoscopic BAL to confirm the diagnosis [2,3,4]. This assumes greater significance in infants ventilated with smaller endotracheal tubes (ETTs) as it is not possible to pass the bronchoscope through these ETTs. In the study mentioned above, the authors have used an LMA to pass the bronchoscope in such infants to obtain a BAL. Such a procedure of replacing an ETT in a child requiring mechanical ventilation with an LMA for a diagnostic procedure is fraught with danger and cannot be universally recommended. In fact, the LMA is relatively contraindicated for bronchoscopy in patients in whom endotracheal intubation and intermittent positive pressure ventilation offers a safer alternative [5]. The absence of complications in this particular study cannot justify this practice.

Alternative methods of obtaining uncontaminated lower airway samples for culture such as a mini-BAL, blind bronchoscopic sampling and non-bronchoscopic BAL are acceptable for routine clinical practice [3,4] and can be used safely in ventilated infants.

References

1. Sachdev A, Chugh K, Sethi M, Gupta D, Wattal C, Menon G. Clinical pulmonary imfection score to diagnose ventilator-associated pneumonia in children. Indian Pediatr. 2011;48:949-53.

2. Lodha R, Kabra SK. Diagnosis of ventilator associated pneumonia: is there a simple solution. Indian Pediatr. 2011;48:939-40.

3. Venkatachalam V, Hendley JO, Willson DF. The diagnostic dilemma of ventilator-associated pneumonia in critically ill children. Pediatr Crit Care Med. 2011;12:286-96.

4. Foglia E, Meier MD, Elward A. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev. 2007;20:409-25.

5. Slonim AD, Ognibene FD. Enhancing patient safety for pediatric bronchoscopy. Alternatives to conscious sedation. Chest. 2001;120:341-2.

 

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