Bronchoscopic and nonbronchoscopic methods of airway culturing in tracheostomized children.

INTRODUCTION Distal airway secretions can be sampled by bronchoscopic bronchoalveolar lavage (B-BAL), blind protected BAL (BP-BAL), and tracheal aspiration (TA). We quantitatively compared the cultures of distal airway secretions from BP-BAL, B-BAL, and TA specimens, and assessed the efficacy of the three above methods in diagnosing bronchitis in tracheostomized children. METHODS Twenty children with tracheostomies underwent BP-BAL, B-BAL, and TA. Samples were sent for quantitative bacterial cultures. The diagnosis of bronchitis was made based on a validated visual grading system as well as on positive quantitative cultures from the BAL fluid. Diagnostic agreement between cultures obtained by the three methods and the visual grading scores was determined by kappa statistics. RESULTS The diagnosis of bronchitis by visual grading score had substantial agreement with BP-BAL, moderate agreement with B-BAL, and fair agreement with TA results. BP-BAL specimens had significantly lower pathogenic colonies (P < .05) than either B-BAL or TA specimens. CONCLUSIONS BP-BAL allows for more accurate sampling of lower airway secretions in tracheostomized children and is more accurate in the diagnosis of bronchitis in this group.