Journal Article

Safety of research bronchoscopy in critically ill patients

Andrews, Joel, Martin, Greg S., Prebil, Sarah E.W., Esper, Annette, Cribbs, Sushma K.

2014

Overview

Bronchoscopy and bronchoalveolar lavage (BAL) are common procedures in intensive care units; however, no contemporaneous safety and outcomes data have been reported, particularly for critically ill patients. This is a retrospective analysis of prospectively collected data from teaching hospital adult intensive care units. One hundred mechanically ventilated patients with severe sepsis, septic shock, acute lung injury (ALI), and/or acute respiratory distress syndrome underwent bronchoscopy with unilateral BAL. Data collected included demographics, presence of sepsis or ALI, Pao2 to Fio2 ratio, positive end-expiratory pressure, Acute Physiology and Chronic Health Evaluation score, Sequential Organ Failure Assessment score, and peri- or postprocedural complications. Men comprised 51% of the patients; 81% of the patients were black, and 15% were white. The mean age was 52 (SD, ±16) years. The mean Acute Physiology and Chronic Health Evaluation score was 22 (±7.5), whereas the median Sequential Organ Failure Assessment score was 9 (interquartile range, 5-12). Ten patients (10%) had complications during or immediately after the procedure. Hypoxemia during or immediately after the BAL was the most common complication. Ninety percent of the complications were related to transient hypoxemia, whereas bradycardia and hypotension each occurred in 1 patient. Age, female sex, and higher positive end-expiratory pressure were associated with complications. Bronchoscopy with BAL in critically ill patients with sepsis and ALI is well tolerated with low risk of complications, primarily related to manageable hypoxemia.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Acute Lung Injury - complications / Adult / Aged / APACHE / Bronchoalveolar lavage / Bronchoalveolar Lavage - adverse effects / Bronchoalveolar Lavage - methods / Bronchoscopy / Bronchoscopy - adverse effects / Bronchoscopy - methods / Complications / Confidence intervals / Consent / Critical Care / Critical Illness / Critically ill / Female / Humans / Hypotension - etiology / Hypoxia - etiology / Intensive care / Intensive Care Units / Male / Mechanically ventilated / Middle Aged / Mortality / Organ Dysfunction Scores / Patients / Positive-Pressure Respiration - adverse effects / Pulmonary arteries / Respiratory distress syndrome / Respiratory Distress Syndrome, Adult - etiology / Retrospective Studies / Review boards / Safety / Sepsis / Sex Factors / Shock, Septic - complications / Studies / Ventilation / Ventilators