An intubated, mechanically ventilated patient is suspected of ...

[torybrooks]

An intubated, mechanically ventilated patient is suspected of developing nosocomial pneumonia. The pulmonologist decides to perform a bronchoscopy. Which bronchoscopy findings would be consistent with pneumonia?
 
  1. Alveolar collapse
  2. Distal purulent secretions
  3. Persistent secretions surging from distal bronchi during exhalation
  4. P/F ratio less than 50
  a. 2, 3, and 4 only
  b. 1 and 3 only
  c. 2 only
  d. 3 and 4 only

Question 2

In order to determine the presence of ventilator-associated pneumonia, what diagnostic proce-dure might be done by a respiratory therapist?
 
  a. Bronchial biopsy
  b. Mini bronchoalveolar lavage
  c. Protected specimen brush
  d. Transthoracic ultrathin needle aspiration

[yasmin]

Answer to Question 1

ANS: A
Direct visualization by bronchoscopy of the lower airway in ventilated patients is sometimes helpful in supporting the diagnosis of VAP. In one recent study, the presence of distal, purulent secretions; persistence of secretions surging from distal bronchi during exhalation; and a decrease in the PaO2/FiO2 ratio of less than 50 were independently associated with the presence of pneu-monia.

Answer to Question 2

ANS: B
Recently, mini-BAL performed by RTs has been advocated for diagnosing VAP. In one study, results obtained using this technique were comparable with those obtained by bronchoscopy us-ing PSB.