Stable patients receiving prolonged mechanical ventilation have a high alveolar burden of bacteria.

INTRODUCTION In patients receiving prolonged mechanical ventilation (PMV), quantitative bronchoscopic culture has not been validated for the diagnosis of ventilator-associated pneumonia (VAP). OBJECTIVE To measure the alveolar burden of bacteria in patients receiving PMV. SETTING Respiratory care units of a university hospital and a long-term care facility. PATIENTS Fourteen patients requiring PMV without clinical evidence of pneumonia. MEASUREMENTS Quantitative culture of BAL from the right middle lobe and lingula. RESULTS In 29 of 32 lobes, there was growth of at least one organism at > 10(4) cfu/mL. Most lobes had polymicrobial growth. CONCLUSIONS Stable patients receiving PMV without clinical pneumonia have a high alveolar burden of bacteria. The bacterial burden in most patients exceeds the commonly accepted threshold for diagnosing VAP. The utility of quantitative bronchoscopic culture in the diagnosis of VAP in this patient population requires further study.