Protected specimen brush

Uses quantitative culture of endotracheal aspirates, bronchoalveolar lavage (BAL), or protected specimen brush (PSB). 

Marik PE, Brown WJ. A comparison of bronchoscopic vs bhnd protected specimen brush sampling in patients with suspected ventilator-associated pneumonia. Chest 1995 108 203-207. 

Fagon JY, Chastre J, Domart Y, et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 1989 139 877-884. 

Figure 2 Correlation between quantitative cultures of endotracheal aspirate and protected specimen brush specimens in 57 ventilator-dependent patients in whom pulmonary infection is chnically thought to have developed. Each point represents a single microorganism. (From Ref. 51, with permission).

Table 3 Methcxiology of the Protected Specimen Brush Technique...

Advance the protected specimen brush (PSB) catheter 3 cm out of the FOB into... 

Lung tissue Protected specimen brush Bronchoalveolar lavage... 

Several investigators argue that the use of bronchoscopy in the evaluation of nosocomial pneumonia is limited by the lack of standardized, reproducible methods and diagnostic criteria (24). There is no doubt that the literature is replete with variations on this theme what are the advantages of bronchoal-veolar lavage (BAL) versus protected specimen brush (PSB) whether to collect secretions with the PSB under direct vision or wedge it distally what... 

Pham EH, Brun Buisson C, Legrand P, et al. Diagnosis of nosocomial pneumonia in mechanically ventilated patients. Comparison of a plugged telescoping catheter with the protected specimen brush. Am Rev Respir Dis 1991 143 1055-1061. 

Baughman RP, Thorpe JE, Staneck J, et al. Use of the protected specimen brush in patients with endotracheal or tracheostomy tubes. Chest 1987 91 233-236. 

Chastre J, Viau F, Brun P, et al. Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated patients. Am Rev Respir Dis 1984 130 924-929. 

Chastre J, Fagon JY, Soler P, et al. Diagnosis of nosocomial bacterial pneumonia in intubated patients undergoing ventilation comparison of the usefulness of bronchoalveolar lavage and the protected specimen brush. Am J Med 1988 85 499-506. 

Montravers P, Fagon JY, Chastre J, et al. Follow-up protected specimen brushes to assess treatment in nosocomial pneumonia. Am Rev Respir Dis 1993 147 38-44. 

Torres A, Martos J, Puig de la Bellacasa, et al. Specificity of endotracheal aspiration, protected specimen brush and bronchoalveolar lavage cultures in mechanically ventilated patients without pneumonia. Am Rev Respir Dis 1993 147 952-957. 

Timsit JF, Misset B, Francoual S, Goldstein W, Vaury P, Carlet J. Is protected specimen brush a reproducible method to diagnose ICU-acquired pneumonia. Chest 1993 104 104-108. 

Blavia R, Dorca J, Verdaguer R, Carratala J, Gudiol F, Manresa F. Bacteriological follow-up of nosocomial pneumonia by successive protected specimen brushes (abstr). Eur Respir J 1991 4 A823. 

Souweine B, Veber B, Bedos IP, et al. Diagnostic accuracy of protected specimen brush and bronchoalveolar lavage in nosocomial pneumonia impact of previous antimicrobial treatments. Crit Care Med 1998 26 236-244. 

Because of these problems, a group of investigators recently formulated recommendations for standardization of methods used to diagnose ventilator-associated pneumonia. These methods involve bronchoscopic techniques (e.g., quantitative culture of protected-specimen brushings, bronchoalveolar lavage, and protected bronchoalveolar lavage). The reported sensitivities and specificities of these methods have ranged from 70% to 100% and 60% to 100%, respectively (7). 

PSB, protected specimen brush VAP, ventilator-associated pneumonia Adapted from Ref. 22. 

Kollef MH. Ventilator-associated pneumonia. JAMA 1993 270 1965-1970. Fagon J, Chastre J, Domart Y, Trouillet J, Gibert C. Mortality due to ventilator-associated pneumonia or colonization with Pseudomonas or Acinetobacter species assessment by quantitative culture of samples obtained by a protected specimen brush. Clin Infect Dis 1996 23 538-542. 

A more recent study (53), which focused on the potential role of anaerobes in ventilator-associated pneumonia (VAP) by applying strict diagnostic criteria (i.e., the recovery of >10 CFU/mL from protected specimen brushes) and by incorporating optimal culture methods for the isolation of anaerobes, found that, of 130 patients, 100 of them (77%) had aerobic organisms isolated alone whereas anaerobes were identified in 30 (23%) cases. Of the latter 30 patients, 26 (87%) of the cases were associated with aerobic bacteria anaerobes alone were reeovered from the remaining four (13%) patients. 

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