Sputum induction has been popularized in the literature as a highly sensitive, noninvasive method for diagnosing Pneumocystis carinii pneumonia (PCP) in patients with the acquired immunodeficiency syndrome (AIDS). Experience at our institution suggested that the sensitivity of simple sputum induction for the detection of pneumocystis infections was considerably lower than the 55-79% previously reported. METHODS: We compared sputum induction with a nasotracheal-suction-and-lavage procedure in 43 patients felt to be at high risk for PCP of whom 19 were eventually found to have pneumocystis infections. RESULTS: Sputum induction using aerosolized hypertonic saline was found to be a relatively insensitive test, while the nasotracheal-suction-and-lavage procedure had an overall sensitivity of 89%, comparable to bronchoscopy. As anticipated, there was more discomfort associated with suctioning than with simple sputum induction. Critical hypoxemia was seen in two patients, but it was transient. Otherwise, adverse effects were not seen. CONCLUSION: We conclude that nasotracheal suction with lavage offers a sensitive, safe, and cost-effective alternative to bronchoscopy for the diagnosis of PCP in high-risk patients.
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