Respiratory samples (tracheal secretions and expectorated sputa) were collected after the initial clinical assessment or within 24 h of admission. TS was performed according to local guidelines. The patient was placed in Fowler’s position and encouraged to clear the airways with a deep cough. The suction catheter (EXTRUDAN Surgery Aps, Denmark, CH12, 530 mm) tip was lubricated with Xylocaine (lidocaine HCl) 2% jelly, inserted into the nares during inhalation, and gently advanced about 40 cm without applying suction. Suction was performed at 200–400 mmHg negative pressure before withdrawing the catheter. FETIS was performed according to a standardized protocol [21 (link)] and was based on the patients’ attempts to deliver a sputum sample. It included ng FET alone and induced sputum (IS) combined with FET [5 (link),23 ]. The patient was placed in a 90° sitting position, the mouth was cleared with water to minimize oropharyngeal contamination, and the sample was obtained by forced exhalation and coughing [5 (link)]. Using the same procedure, a second sputum sample was obtained after inhalation of nebulized isotonic saline (Unomedical Opti-Mist TM, 2.1 m, ref. 93–772 mm) [23 ]. Hence, each patient in the intervention group (FETIS) could deliver two samples. Participants in the intervention group who could not deliver a sputum sample by FETIS underwent tracheal suction (TS-IG); these samples were also included in the secondary analysis [21 (link)].
Free full text: Click here
