Protected Specimen Brush (PSB) or Bronchoalveolar Lavage (BAL) for Diagnosing Ventilator-Associated Pneumonia

Abstract

Background: Ventilator-associated pneumonia (VAP) is a common and serious infection in
intubated patients, leading to increased mortality, longer ICU stays, and higher healthcare costs.
Accurate diagnosis is essential for effective treatment and to prevent antibiotic misuse.
Purpose: This study investigates whether bronchoalveolar lavage (BAL) and protected specimen
brush (PSB) yield similar culture results in ICU patients with suspected or confirmed VAP.
Methods: A retrospective study was conducted on ICU patients with VAP at Shar Hospital,
Sulaymaniyah, Iraq, from 2020 to 2023. Patients on ventilators for ≥48 hours with new lung infiltrates
who underwent both BAL and PSB were included. Spearman's correlation was used to compare
culture results.
Results: Out of 56 VAP patients, 20 met inclusion criteria. Bacteria were detected in 48% of BAL
and 43% of PSB samples. A significant correlation was found between BAL and PSB results
(correlation coefficient 0.846, p < 0.01), with 96% agreement in detected agents.
Conclusion: PSB and BAL provide comparable results for diagnosing VAP, but PSB might be
preferred due to its specificity and lower risk of procedural complications. Correct BAL technique,
involving adequate saline flushing, is essential for accurate results. Further studies should standardize
BAL procedures to optimize diagnostic accuracy