Tolerability of Broncho-Alveolar Lavage in Ventilated Patients with Acute Lung Injury 

Authors

  • A.R. Medford North Bristol Lung Centre & University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
  • A.B. Millar North Bristol Lung Centre & University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK and Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Second Floor, Learning and Research, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK

DOI:

https://doi.org/10.12974/2312-5470.2014.01.01.2

Keywords:

Broncho-alveolar lavage, acute respiratory distress syndrome, safety, acute lung injury, intensive care.

Abstract

Broncho-alveolar lavage (BAL) is an important diagnostic tool in many areas of thoracic medicine. On the intensive care unit (ICU), BAL is often required for a variety of indications, including assessment of possible ventilator-associated pneumonia (VAP). Recent data suggest BAL may be superior to less invasive techniques in the assessment of VAP. Older studies have highlighted potential concerns over the safety of BAL in ICU patients but this has not been confirmed in more recent studies in patients with acute respiratory distress syndrome (ARDS). This prospective cohort study aimed to clarify the tolerability of BAL in 162 ventilated ICU patients with ARDS and possible VAP.

BAL was tolerated very well with only 2 patients (1.2%) demonstrating a mild desaturation (fall of 6% in oxygen saturation) due to 1 episode of bronchospasm and secretion retention respectively which were resolved quickly. No major complications or deaths occurred and BAL samples were obtained for microbial analysis in all patients. We conclude BAL is well tolerated in carefully selected and prepared ventilated ICU patients with ARDS in whom VAP is being considered. Further large scale controlled studies comparing BAL to less invasive techniques are indicated in this cohort. 

References

Fagon JY. Diagnosis and treatment of ventilator-associated pneumonia: fiberoptic bronchoscopy with bronchoalveolar lavage is essential. Semin Respir Crit Care Med 2006; 27(1): 34-44. http://dx.doi.org/10.1055/s-2006-933672

Fagon JY, Chastre J, Vuagnat A, Trouillet JL, Novara A, Gibert C. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996; 275(11): 866-9. http://dx.doi.org/10.1001/jama.1996.03530350048033

Rello J, Quintana E, Ausina V, Castella J, Luquin M, Net A, et al. Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients. Chest 1991; 100(2): 439-44. http://dx.doi.org/10.1378/chest.100.2.439

American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcareassociated pneumonia. Am J Respir Crit Care Med 2005; 171(4): 388-416. http://dx.doi.org/10.1164/rccm.200405-644ST

Baselski VS, el-Torky M, Coalson JJ, Griffin JP. The standardization of criteria for processing and interpreting laboratory specimens in patients with suspected ventilatorassociated pneumonia. Chest 1992; 102(5 Suppl 1): 571S- 579S. http://dx.doi.org/10.1378/chest.102.5_Supplement_1.571S

Fagon JY, Chastre J, Wolff M, Gervais C, Parer-Aubas S, Stéphan F, et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial. Ann Intern Med 2000; 132(8): 621-30. http://dx.doi.org/10.7326/0003-4819-132-8-200004180- 00004

Sanchez-Nieto JM, Torres A, Garcia-Cordoba F, El-Ebiary M, Carrillo A, Ruiz J, et al. Impact of invasive and noninvasive quantitative culture sampling on outcome of ventilatorassociated pneumonia: a pilot study. Am J Respir Crit Care Med 1998; 157(2): 371-6. http://dx.doi.org/10.1164/ajrccm.157.2.97-02039

Sole Violan J, Fernandez JA, Benitez AB, Cardeñosa Cendrero JA, Rodríguez de Castro F. Impact of quantitative invasive diagnostic techniques in the management and outcome of mechanically ventilated patients with suspected pneumonia. Crit Care Med 2000; 28(8): 2737-41. http://dx.doi.org/10.1097/00003246-200008000-00009

Ruiz M, Torres A, Ewig S, Marcos MA, Alcón A, Lledó R, et al. Noninvasive versus invasive microbial investigation in ventilator-associated pneumonia: evaluation of outcome. Am J Respir Crit Care Med 2000; 162(1): 119-25. http://dx.doi.org/10.1164/ajrccm.162.1.9907090

Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 2006; 355(25): 2619-30. http://dx.doi.org/10.1056/NEJMoa052904

Medford AR, Husain SA, Turki HM, Millar AB. Diagnosis of ventilator-associated pneumonia. J Crit Care 2009; 24(3): 473.e1-6.

Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax 2013; 68 Suppl 1: i1-i44. http://dx.doi.org/10.1136/thoraxjnl-2013-203618

Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med 2000; 342(18): 1334-9. http://dx.doi.org/10.1056/NEJM200005043421806

Bauer TT, Torres A, Ewig S, Hernandez C, Sanchez-Nieto JM, Xaubet A, et al. Effects of bronchoalveolar lavage volume on arterial oxygenation in mechanically ventilated patients with pneumonia. Intensive Care Med 2001; 27(2): 384-93. http://dx.doi.org/10.1007/s001340000781

Steinberg KP, Mitchell DR, Maunder RJ, Milberg JA, Whitcomb ME, Hudson LD. Safety of bronchoalveolar lavage in patients with adult respiratory distress syndrome. Am Rev Respir Dis 1993; 148: 556–61. http://dx.doi.org/10.1164/ajrccm/148.3.556

Medford AR, Godinho SI, Keen LJ, Millar AB. Relationship between vascular endothelial growth factor + 936 genotype and plasma/epithelial lining fluid vascular endothelial growth factor protein levels in patients with and at risk for ARDS. Chest 2009; 136(2): 457-64. http://dx.doi.org/10.1378/chest.09-0383

Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. The Consensus Committee. Intensive Care Med 1994; 20(3): 225-232. http://dx.doi.org/10.1007/BF01704707

Perkins GD, Chatterjee S, Giles S, McAuley DF, Quinton S, Thickett DR, et al. Safety and tolerability of nonbronchoscopic lavage in ARDS. Chest 2005; 127(4): 1358-63. http://dx.doi.org/10.1378/chest.127.4.1358

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Published

2014-02-05

How to Cite

Medford, A., & Millar, A. (2014). Tolerability of Broncho-Alveolar Lavage in Ventilated Patients with Acute Lung Injury . Global Journal of Respiratory Care, 1(1), 9–12. https://doi.org/10.12974/2312-5470.2014.01.01.2

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