Intensive Care Med (1992) 18:410-414 IntensiveCare Medicine 9 Springer-Verlag 1992 Diagnostic value of the blind brush in mechanically ventilated patients with nosocomial pneumonia S.R. Leal-Noval, E. Alfaro-Rodrlguez, F. Murillo-Cabeza, J. Garnacho-Montero, J. Rey-Perez and M.A. Mtifioz-Sfinchez Servicio de Cuidados Intensivos, Hospital Universitario "Virgen del Rocio", C/Manuel Siurot S/N, Sevilla, Spain Received: 3 December 1991; accepted: 11 May 1992 Abstract. Objectives: To check on the accuracy of a new protected blind brush (BB) inserted through an en- dotracheal tube to collect respiratory secretions to be used in the diagnosis of nosocomial pneumonia (NP) in ventilated patients. Design: Prospective study of patients who had undergone both BB and plugged telescoping catheter via fiberoptic bronchoscopy (PTC-FB) sample collection sessions. Setting: Intensive Care Unit of a re- ferral-based University Hospital. Patients." All patients (n = 37) mechanically ventilated for more than 3 days with clinical and radiological criteria of NP between July 1990 and March 1991. Interventions: Randomized BB and PTC-FB sample collection sessions carried out less than 30 min apart. Measurements and main results." The two sampling procedures resulted in similar findings with both cultures either negative or positive and identified the same organism and colonies in 31 patients (83.7%). Agreement was 90% when the patients with right or bi- lateral pulmonary infiltrates were grouped together and 100% when only the right field was considered. Compli- cations arising from BB sampling were much lower than those from the conventional PTC-FB technique. Conclu- sions: Our results, pending confirmation by other pro- spective studies, indicate that BB sampling is useful in the diagnosis of NP in ventilated patients with radiological evidence of either right or bilateral pulmonary infiltrates and that it could stand in for PTC-FB in ICU settings where this procedure is not available. Key words: Plugged telescoping catheter - Fiberoptic bronchoscope - Blind brush catheter - Nosocomial pneumonia Nosocomial Pneumonia (NP) is the second most com- mon hospital acquired infection and the foremost cause of morbidity and death [1, 2]. Clinical and radiological criteria customarily used to diagnose NP in mechanically ventilated patients, especially for those with preexisting underlying lung disease, are relatively unreliable [3]. Fur- thermore, cultures grown from conventional tracheal as- pirate specimens are of poor diagnosis value due to con- tamination by microorganisms which often form colonies in the upper airways of patients with endotracheal or tracheostomy tubes in place [4, 51. Since its introduction by Wimberley et al. [6], the pro- cedure to collect brushing samples of respiratory secre- tions through a plugged telescoping catheter inserted in a fiberoptic bronchoscope (TPC-FB) has not only proved to be reliable in the etiologic diagnosis of NP but it also protects specimens from upper airway contamination. Quantitative cultures are necessary to avoid false positive results when employing this procedure and a threshold of 103 colony-forming units/ml (cfu/ml) will adequately distinguish colonizing organisms from NP infections [6-9]. However, facilities and qualified personnel are re- quired to carry out the FB procedure, both of which are not universally available. This method may also bring about serious complications such as a decrease in the sat- uration of the arterial blood oxygen (SaO2) [10]. Torres et al. [11] employed a Metras catheter to guide a TPC without fiberoptic bronchoscopy (FB) to collect specimens from 25 ventilated patients and compared cul- ture results with those prepared from samples obtained by 9 the conventional PTC-FB procedure. The sensitivity of both techniques was 100% while the Metras catheter yielded a 61% and the conventional method a 66~ speci- ficity. Gold standard reference methods such as lung biopsies were used to confirm results. Recently a Blind Brush (BB) protected by a balloon- tipped double-sheathed catheter was put on the market, - which could be useful in the diagnosis of NP in venti- lated patients. Preliminary results of a study conducted by Lem et al. [121, suggest that this procedure does cir- cumvent upper airway brush contamination. The aim of this prospective study was to investigate the value of the new BB sampling method in the diagno- sis of NP infections in ventilated patients and compare findings with the conventional PTC-FB technique. Com- plications arising from the two techniques were also com- pared.