Chest
Clinical InvestigationsUse of the Protected Specimen Brush in Patients with Endotracheal or Tracheostomy Tubes
Section snippets
Material and Methods
Patients were recruited from those seen in the medical and surgical intensive care units at the University of Cincinnati Medical Center and the Veterans Administration Medical Center, Cincinnati. Patients were eligible for study if they had been intubated with either an endotracheal tube or tracheostomy tube for at least 48 hours, if they had a new, localized infiltrate on chest roentgenogram either on a normal chest roentgenogram or in addition to diffuse infiltrate already present, as in
Results
We studied a total of 21 patients. The underlying condition in each case is shown in Table 1. All eight pneumonia patients had a clinical course and chest roentgenogram consistent with bacterial pneumonia. In all cases, there was resolution of the localized infiltrate on chest roentgenogram temporally related to the use of antibiotics. In the other 13 cases (nonpneumonia), an alternate diagnosis was arrived at for the cause of the localized infiltrate. Six patients appeared to have the adult
Discussion
The degree of accuracy of diagnosis of pneumonia often depends on the particular patient. Several methods have been proposed for making the diagnosis of pneumonia, many trading safety for accuracy. For example, obtaining an expectorated sputum sample is an inexpensive, innocuous method of providing a specimen for culture of respiratory tract pathogens. However, the frequent contamination of the specimen with oral flora causes significant difficulty in interpreting sputum culture results.8 The
ACKNOWLEDGMENT
The authors wish to thank Jean Walden for help with culturing specimens, Dr. Robert Loudon for his review, and Naomi Sims for secretarial help in preparing this manuscript.
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Supported in Part by Grant No. RR00068-21 from the National Institutes of Health, General Clinical Research Center, University of Cincinnati.
Manuscript received November 14, 1985; revision accepted August 12.