Usage of intra-aortic balloon pump in high risk coronary artery bypass graft surgery.

BACKGROUND: Accurate diagnosis and appropriate treatment of ventilator associatedpneumonia (VAP) is crucial for good outcomes. Endotracheal suctioning is performed inventilated patients as part of routine care and for tracheal toileting. AIM: We evaluatedif quantitative endotracheal aspirate (ETA) was a suitable alternative to bronchoalveolarlavage (BAL) for suspected VAP. In addition we assessed if surveillance ETA guidedantibiotic selection for subsequent VAP. SETTING AND DESIGN: Prospective study inthe surgical intensive care unit (ICU) of a tertiary hospital in India. MATERIALS ANDMETHODS: Two hundred consecutive patients with mean (standard deviation) APACHEII score of 12.3±5 and requiring mechanical ventilation beyond 48 hours underwentsurveillance ETA cultures. A second ETA and BAL were performed if the patient developedfeatures of VAP. The threshold for microbiological diagnosis of VAP was taken as 105colony forming units/ml (cfu/ml) for ETA and104cfu/ml for BAL. STATISTICAL ANALYSIS:The sensitivity and specificity of surveillance and concurrent ETA aspirate cultures werecompared with BAL cultures. RESULTS: VAP was suspected clinically and corroboratedradiologically in 27/177 patients (15.3%). Although microbiological support for VAPwas obtained by ETA in 19 patients, bronchoscopy was possible only in 13 patients, 8 ofwhom had isolates at significant threshold. Of the 16 organisms isolated from BAL, 11were of significant threshold with 9/11 (82%) BAL isolates having a similar antibiogramto a concurrent ETA. Only one BAL isolate (9%), at significant threshold, was not isolatedon a concurrent ETA. On the other hand just 6/11 BAL isolates (55%) had an identicalantibiogram to surveillance ETA. BAL had 3 additional isolates (27%) at significantthreshold not isolated on surveillance ETA. CONCLUSIONS: Concurrent quantitative ETAcould substitute BAL cultures for VAP. Surveillance ETA at 48 hours of ventilation doesnot appear to assist with antibiotic selection for a subsequent VAP.