Informed consent selleck chem Dasatinib was obtained from each patient.PatientsWe included all patients in the emergency department who were diagnosed with HCAP. Pneumonia was defined as the presence of a new infiltrate on a chest radiograph plus one or more of the following: fever (temperature >38.0��C) or hypothermia (temperature <35.0��C); new cough with or without sputum production; pleuritic chest pain; dyspnea; and altered breath sounds on auscultation [6]. HCAP was defined by pneumonia and one or more of the four criteria defined by the American Thoracic Society (ATS) [2]: hospitalized for two or more days in an acute care facility within 90 days before infection; resident of a nursing home or long-term care facility; attending a hospital or hemodialysis clinic, or received recent intravenous antimicrobial therapy, immunosuppressive therapy, or wound care within 30 days of infection.

The exclusion criteria were: age younger than 18 years; use of antiplatelet drugs; use of anti-vitamin K medications; coagulation failure; opposition from the patient; judiciary protection of the patient; and bronchospasm.Diagnostic procedureThe diagnostic procedure was performed after initial symptomatic treatment. Evaluation of level of care and respiratory support needed by the patient was made by the intensivist on clinical grounds and according to published guidelines. Microbiological diagnosis was made as soon as possible, using FODP mini-BAL and blood cultures for each patient performed at the same time. Positive pathogen identification with mini-BAL was defined as >103CFU/mL [8,10].

All patients were on non-invasive ventilation (NIV) (BiPAP Vision?, Philips Respitronics, Amsterdam, Netherlands) throughout the FODP mini-BAL, except for those who required endotracheal intubation prior to the procedure (Figure (Figure1).1). The procedure was performed in the emergency department when the patient did not initially require tracheal intubation. The fiberoptic bronchoscope was positioned in the lobar bronchia where the pneumonia was localized on chest x-ray. The telescopic catheter (Combicath?, Prodimed division Plastimed, Le Plessis-Bouchard, FRANCE) was passed through the bronchoscope operator channel. The internal catheter was placed in the distal position and 20 mL of normal saline was infused, then secretions were removed with a syringe [10-12]. Two series of aerobic and anaerobic blood cultures were conducted at the same time. Blood samples were immediately GSK-3 taken to the laboratory.Figure 1Fiberoptic bronchoscope-guided distal protected small volume bronchoalveolar lavage (FODP mini-BAL). 1) FODP mini-BAL during non invasive ventilation. 2) Specific interface to perform fiberoptic bronchoscopy during non invasive ventilation. 3) Telescopic …