Contamination is particularly troublesome in seriously ill or hospitalized patients who frequently have the upper airways2 or the endotracheal tube^ colonized with potential pathogens, making it difficult or impossible to differentiate infecting from colonizing bacteria. flovent inhaler
Diagnostic modalities have been developed that bypass the oropharynx in order to collect uncontaminated secretions from the lower respiratory tract. Two invasive procedures, transtracheal and transthoracic needle aspiration, have been extensively investigated but have fallen into disfavor because of the risk for serious complications and the evolution in recent years of two bronchoscopic techniques: protected specimen brushing (PSB) and bronchoalveolar lavage (BAL).
Fiberoptic bronchoscopy (FOB) provides, under visualization, direct access to the lower airways for sampling bronchial and parenchymal tissues. To reach the bronchial tree, however, the bronchoscope must traverse the oropharynx or the endotracheal tube, where contamination of the instrument is likely to occur. In a study of 16 patients without lung infection who underwent flexible FOB, Bartlett et al found all bronchoscopic aspirates to be contaminated by oropharyngeal bacteria.
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