Journal Article

Benefit-to-risk balance of bronchoalveolar lavage in the critically ill. A prospective, multicenter cohort study

Bretagnol, Anne, Pierrot, Marc, Baraka Karima, Contou Damien, Mai-Anh, Nay, Fagot Gandet Florence, Herbrecht Jean Etienne, Skarzynski Marie, Grouille Julien, Pierre-François, Dequin, Satar, Morttaza, Guervilly Christophe, Leloup Maxime, Muller, Grégoire, Runge, Isabelle, Paris, Meng, Garret, Charlotte, Jacquier Sophie, Barbier François, Morel Guillaume, Lesieur Olivier, Schenck Maleka, Bercault Nicolas, Mathonnet Armelle, Garot Denis, Harlay Marie Line, Janssen-Langenstein Ralf, Lemeur, Anthony, Boulain Thierry, Kamel Toufik, Helms, Julie, Guillon Antoine, Lerolle Nicolas, Adda, Melanie, Castelain Vincent, Meziani Ferhat, Reignier, Jean, Schneider, Francis, Darwiche Walid, Bodet Contentin Laetitia, Roustan Jérôme, Gwenhaël, Colin, Mercier Emmanuelle, Hraiech Sami, Morisseau Marlene, Clere-Jehl Raphaël, Danielo Vivien, Michard Baptiste, Hoppe, Marie Anne, Jo-Anna, Tirolien, Souday Vincent, Guillot, Max, Maestraggi Quentin, Ehrmann, Stephan, Merdji Hamid, Coudroy Rémi, Bourenne Jeremy, Daviet Florence, Kouatchet Achille, Schnell, David, Quenot Jean Pierre, Vinatier Isabelle, Benzekri-Lefevre Dalila, Papazian, L

2020

Overview

PurposeTo assess the benefit-to-risk balance of bronchoalveolar lavage (BAL) in intensive care unit (ICU) patients.MethodsIn 16 ICUs, we prospectively collected adverse events during or within 24 h after BAL and assessed the BAL input for decision making in consecutive adult patients. The occurrence of a clinical adverse event at least of grade 3, i.e., sufficiently severe to need therapeutic action(s), including modification(s) in respiratory support, defined poor BAL tolerance. The BAL input for decision making was declared satisfactory if it allowed to interrupt or initiate one or several treatments.ResultsWe included 483 BAL in 483 patients [age 63 years (interquartile range (IQR) 53–72); female gender: 162 (33.5%); simplified acute physiology score II: 48 (IQR 37-61); immunosuppression 244 (50.5%)]. BAL was begun in non-intubated patients in 105 (21.7%) cases. Sixty-seven (13.9%) patients reached the grade 3 of adverse event or higher. Logistic regression showed that a BAL performed by a non-experienced physician (non-pulmonologist, or intensivist with less than 10 years in the specialty or less than 50 BAL performed) was the main predictor of poor BAL tolerance in non-intubated patients [OR: 3.57 (95% confidence interval 1.04–12.35); P = 0.04]. A satisfactory BAL input for decision making was observed in 227 (47.0%) cases and was not predictable using logistic regression.ConclusionsAdverse events related to BAL in ICU patients are not infrequent nor necessarily benign. Our findings call for an extreme caution, when envisaging a BAL in ICU patients and for a mandatory accompaniment of the less experienced physicians.

• Publisher: Springer Nature B.V
• Subject: Adverse events / Alveoli / Bronchus / Clinical decision making / Cohort analysis / Confidence intervals / Decision making / Gender / Immunosuppression / Intensive care / Lavage / Patients / Physicians / Regression analysis / Statistical analysis