• Emmanuel Boselli, Dominique Breilh, Sarah Djabarouti, Christian Guillaume, Thomas Rimmelé, Jean-Baptiste Gordien, Fabien Xuereb, Marie-Claude Saux, and Bernard Allaouchiche.
• Hôpital Edouard Herriot, Department of Anesthesiology and Intensive Care, 5 place d'Arsonval, 69003 Lyon, France. emmanuel.boselli@chu-lyon.fr
• Intensive Care Med. 2007 Sep 1; 33 (9): 1519-23.

ObjectiveTo evaluate the reliability of mini-bronchoalveolar lavage (mini-BAL) for the measurement of tobramycin concentrations in epithelial lining fluid (ELF) in comparison with conventional bronchoscopic bronchoalveolar lavage (BAL).DesignProspective, open-label study.SettingAn intensive care unit and research ward in a university hospital.PatientsTwelve critically ill adult patients with ventilator-associated pneumonia (VAP).InterventionsAll subjects received intravenous infusions of tobramycin 7-10 mg/kg once daily. After 2 days of therapy, the steady-state serum and ELF concentrations (obtained from BAL and mini-BAL) of tobramycin were determined by means of high-performance liquid chromatography.Measurements And ResultsWe observed poor penetration of tobramycin in ELF of approximately approximately 12% with ELF peak concentrations of approximately approximately 3 mg/l with both methods. Good agreement in Bland-Altman analysis (mean +/- SD bias = 0.04 +/- 0.38 mg/l) was observed between the two methods of sampling.ConclusionOur results suggest that tobramycin 7-10 mg/kg once daily in critically ill patients with VAP might provide insufficient lung concentrations in the case of difficult-to-treat pathogens. Besides, mini-BAL, which is simple, non-invasive and easily repeatable at the bedside, appears to be a reliable method for the measurement of antibiotic concentrations in ELF in comparison with bronchoscopic BAL in critically ill patients with VAP.

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