RESUMO
BACKGROUND: Bronchoscopic sampling of bronchoalveolar fluid (BAL) should be safe and effective. Current sampling practice risks loss of sample to the attached negative flow, aerosolisation, or spillage, due to repeated circuit breaks, when replacing sample containers. Such concerns were highlighted during the recent coronavirus pandemic. OBJECTIVES: Evaluation of an alternative integrated sampling solution, with the Ambu Bronchosampler with aScope 4, by an experienced bronchoscopist in ICU. METHODS: An observational study of 20 sequential bronchoscopic diagnostic sampling procedures was performed on mechanically ventilated patients with suspected ventilator-associated pneumonia. Mixed methods assessment was done. The predefined outcome measures were (1) ease of set up, (2) ease of specimen collection, (3) ease of protecting specimen from loss or spillage, and (4) overall workflow. The duration of the procedure and the % volume of sample retrieved were recorded. RESULTS: The mean (±standard deviation [SD]) time for collecting 1 sample was 2.5 ± 0.8 min. The mean (±SD) specimen yield for instilled miniBAL was 54.2 ± 17.9%. Compared with standard sampling, the set-up was much easier in 18 (90%), or easier in 2 (10%) of procedures, reducing the connection steps. It was much more intuitive to use in 14 (70%), more intuitive in 4 (20%), and no more intuitive to use in 2 (10%). The overall set-up and workflow was much easier in 69% of the 13 intraprocedural connections and easier or as easy in the remaining 31% procedures. All procedures where pre connection was established were much easier (7, 100%). The Ambu Bronchosampler remained upright in all procedures with no loss or spillage of sample. Obtaining a sample was much easier in 60%, easier in 10%, no different in 20%, and worse in 10%. The ability to protect a sample from start to finish compared to standard procedures was much easier in 80%, easier in 15%, and no different in 5% of procedures. Overall workflow was much easier in 14 (70%), easier in 4 (20%), and no different in 2 (10%) of procedures. CONCLUSIONS: The Ambu Bronchosampler unit was a reliable, effective, and possibly safer technique for diagnostic sampling in ICU. It may improve safety standards during the coronavirus pandemic. A randomized control trial against the standard sampling technique is warranted.
Assuntos
Broncoscópios , Broncoscopia/métodos , Equipamentos Descartáveis , Respiração Artificial , Manejo de Espécimes/métodos , Lavagem Broncoalveolar/instrumentação , Lavagem Broncoalveolar/métodos , Líquido da Lavagem Broncoalveolar , Broncoscopia/instrumentação , COVID-19/prevenção & controle , COVID-19/transmissão , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Exposição Ocupacional/prevenção & controle , Isoladores de Pacientes , Equipamento de Proteção Individual , Pneumonia Associada à Ventilação Mecânica/diagnóstico , Medição de Risco , SARS-CoV-2RESUMO
Background and objectives: Persistent wheezing (PW) is defined as prolonged or recurrent episodes of wheezing despite regular treatment. Flexible bronchoscopy (FB) is recommended to determine the etiology of PW in children. This study aimed to determine the etiology of PW based on FB findings in a national pediatric center. Materials and Methods: Children presenting with PW that underwent flexible bronchoscopy from April 2016 to August 2019 at the Mother and Child Health Institute of Serbia were included in this observational study. After endoscopic evaluation, bronchoalveolar lavage fluid (BALF) samples were taken and further analyzed. Quantitative microbiology, cytological analysis and oil-red staining of specimens were performed to determine cellular constituents and presence of lipid laden macrophages (LLM). Upper gastrointestinal series were performed to exclude gastroesophageal reflux disease, swallowing dysfunction and vascular ring. Results: Pathological findings were revealed in 151 of 172 study participants, with bacterial lower airway infection (BLAI) (48.3%) and primary bronchomalacia (20.4%) as the most common. Younger participants were hospitalized for significantly longer periods (ρ = -0.366, p < 0.001). Study participants with BLAI and associated mucus plugging were notably younger (p < 0.001). Presence of LLM in BALF was not associated with findings of upper gastrointestinal series. All patients with confirmed BLAI were treated with oral antibiotics. Although FB is considered to be invasive, there were no complications associated with the procedure. Conclusions: Flexible bronchoscopy has an exceptional diagnostic value in evaluation of PW. In younger patients with BLAI, presence of mucus plugs may complicate the clinical course, so significant benefits can be achieved with therapeutic lavage during bronchoscopy.
Assuntos
Broncoscópios/normas , Broncoscopia/instrumentação , Broncoscopia/métodos , Sons Respiratórios/diagnóstico , Sons Respiratórios/fisiopatologia , Adolescente , Lavagem Broncoalveolar/instrumentação , Lavagem Broncoalveolar/métodos , Broncoscopia/normas , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , SérviaAssuntos
Lavagem Broncoalveolar/métodos , Dispneia/terapia , Intubação Intratraqueal/métodos , Proteinose Alveolar Pulmonar/terapia , Lavagem Broncoalveolar/instrumentação , Dispneia/etiologia , Humanos , Lactente , Intubação Intratraqueal/instrumentação , Masculino , Proteinose Alveolar Pulmonar/complicações , Resultado do TratamentoRESUMO
This case demonstrates the airway management of a pediatric patient with short stature due to STAT5b deficiency, a rare genetic immunodeficiency associated with lung disease and endocrinopathy. The patient had recurrent pulmonary infections and pulmonary alveolar proteinosis (PAP) for which whole lung lavage (WLL) was recommended. Due to short stature and overall body habitus, the patient's airway would not accommodate a traditional double-lumen tube (DLT). Therefore, we placed 2 single-lumen breathing tubes: 1 endobronchial and 1 endotracheal, to mimic a DLT and facilitate WLL, demonstrating a viable option for lung isolation in the absence of purpose-built equipment.
Assuntos
Lavagem Broncoalveolar/instrumentação , Pulmão/anormalidades , Proteinose Alveolar Pulmonar/terapia , Adolescente , Nanismo/complicações , Nanismo/metabolismo , Nanismo/patologia , Feminino , Humanos , Fator de Transcrição STAT5/deficiência , Resultado do TratamentoRESUMO
OBJECTIVE: The objective of this retrospective review was to evaluate the perioperative and procedural management of patients with pulmonary alveolar proteinosis (PAP) who presented for whole-lung lavage (WLL). DESIGN: The records of all adult patients with PAP who underwent WLL between January 1, 1988 and August 20, 2017 were reviewed and pertinent demographic, preoperative, anesthetic, procedural, and postoperative data were recorded. SETTING: Large academic tertiary referral center. PARTICIPANTS: Forty patients with PAP underwent 79 WLL procedures. INTERVENTIONS: Patients with PAP undergoing WLL. MEASUREMENTS: Successful WLL, defined by visual clearing of lavage fluid, was completed in 91% of cases. Whole-lung lavage was terminated prematurely in 9% of cases (refractory hypoxia most common), while 8% of cases were found to have 30-day complications. There were no cases of intraoperative death, hemodynamic collapse, pneumothorax or hydrothorax, or need for emergent reintubation. Postoperative clinical follow-up at the authors' institution within 6 months of WLL showed 68% of patients reported improvement in symptoms and/or functional status. CONCLUSION: The authors here present a retrospective study describing the perioperative and procedural management of PAP patients undergoing WLL to help familiarize providers with the management of this population (Fig 1). The findings of this study outline a successful and consistent approach to WLL using a multidisciplinary team experienced in this procedure. Even in experienced hands, procedural complications and 30-day postoperative complications emphasize the risk in this complex patient population.
Assuntos
Lavagem Broncoalveolar/métodos , Avaliação de Resultados da Assistência ao Paciente , Proteinose Alveolar Pulmonar/diagnóstico por imagem , Proteinose Alveolar Pulmonar/cirurgia , Adulto , Lavagem Broncoalveolar/instrumentação , Líquido da Lavagem Broncoalveolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Nanoparticles can enter the body via the lungs, the digestive tract, and the skin. The pulmonary effects of nanoparticles and the underlying mechanisms may be investigated by histopathological examination, immunostaining, bronchoalveolar lavage (BAL), and so on. BAL is a simple, fast, and inexpensive method that is commonly used to investigate the immune cells and acellular components in the lungs, which reflect the health state of the lungs. In this chapter, we describe the detailed procedures of performing BAL on mouse lungs. In a typical procedure, a catheter is inserted in the exposed trachea of a mouse, through which a phosphate-buffered saline (PBS) solution containing ethylenediaminetetraacetic acid (EDTA) is instilled into the lungs by a syringe. BAL fluid (BALF) is collected by gently retracting the instilled solution and massaging the thoracic cavity to maximize BALF retrieval and to minimize shearing forces. The type and number of differentiated immune cells in the BALF are analyzed, and the soluble factors such as total proteins, chemokines, and cytokines in the BALF are determined by protein assay, ELISA, etc.
Assuntos
Lavagem Broncoalveolar/métodos , Pulmão/patologia , Nanopartículas/toxicidade , Animais , Lavagem Broncoalveolar/instrumentação , Líquido da Lavagem Broncoalveolar/química , Líquido da Lavagem Broncoalveolar/citologia , Ensaio de Imunoadsorção Enzimática/instrumentação , Ensaio de Imunoadsorção Enzimática/métodos , Camundongos , Camundongos Endogâmicos C57BL , Nanopartículas/administração & dosagem , Testes de Toxicidade/instrumentação , Testes de Toxicidade/métodosRESUMO
BACKGROUND In many studies, confocal laser endomicroscopy (CLE) has proven to be a useful tool in pulmonology; nevertheless, the application in this field is still experimental. By contrast, CLE is almost a standard technique in gastroenterology. The aim of the present study was to demonstrate the identification of bronchoalveolar lavage (BAL) components applying CLE, using a dye. MATERIAL AND METHODS In 21 patients with various underlying diseases a bronchoscopy with BAL was performed. As in routine clinical practice common, BAL fluid (BALF) was analyzed in terms of cytologic, virologic, and microbiologic aspects. To one fraction of BALF, we added acriflavine. After centrifugation CLE was applied and the video sequences were analyzed by an experienced investigator. RESULTS Using CLE, BALF components (such as alveolar macrophages or leucocytes) could be easily identified. A further subdivision of leucocytes (neutrophilic, eosinophilic granulocytes, and lymphocytes) was not possible. Analogous to conventional cytology, a precise distinction of lymphocyte subpopulation (cd 4/cd 8 ratio) was not feasible. In terms of quantification, this is still the application field of flow cytometry and immunohistochemistry. CONCLUSIONS Using CLE, alveolar macrophages and leucocytes in stained BALF can be differentiated independent of smoking status. Further studies should be initiated in order to subclassify leucocytes in eosinophilic, neutrophilic granulocytes, and lymphocytes, which is important for routine clinical practice.
Assuntos
Lavagem Broncoalveolar/métodos , Broncoscopia/métodos , Endoscopia/métodos , Acriflavina , Adulto , Idoso , Idoso de 80 Anos ou mais , Lavagem Broncoalveolar/instrumentação , Líquido da Lavagem Broncoalveolar/citologia , Feminino , Citometria de Fluxo , Humanos , Masculino , Microscopia Confocal/métodos , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
OBJECTIVE To evaluate the effect of 2 bronchoalveolar lavage (BAL) sampling techniques and the use of N-butylscopolammonium bromide (NBB) on the quantity and quality of BAL fluid (BALF) samples obtained from horses with the summer pasture endophenotype of equine asthma. ANIMALS 8 horses with the summer pasture endophenotype of equine asthma. PROCEDURES BAL was performed bilaterally (right and left lung sites) with a flexible videoendoscope passed through the left or right nasal passage. During lavage of the first lung site, a BALF sample was collected by means of either gentle syringe aspiration or mechanical suction with a pressure-regulated wall-mounted suction pump. The endoscope was then maneuvered into the contralateral lung site, and lavage was performed with the alternate fluid retrieval technique. For each horse, BAL was performed bilaterally once with and once without premedication with NBB (21-day interval). The BALF samples retrieved were evaluated for volume, total cell count, differential cell count, RBC count, and total protein concentration. RESULTS Use of syringe aspiration significantly increased total BALF volume (mean volume increase, 40 mL [approx 7.5% yield]) and decreased total RBC count (mean decrease, 142 cells/µL), compared with use of mechanical suction. The BALF nucleated cell count and differential cell count did not differ between BAL procedures. Use of NBB had no effect on BALF retrieval. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that retrieval of BALF by syringe aspiration may increase yield and reduce barotrauma in horses at increased risk of bronchoconstriction and bronchiolar collapse. Further studies to determine the usefulness of NBB and other bronchodilators during BAL procedures in horses are warranted.
Assuntos
Asma/veterinária , Líquido da Lavagem Broncoalveolar , Lavagem Broncoalveolar/veterinária , Brometo de Butilescopolamônio/farmacologia , Doenças dos Cavalos/diagnóstico , Sucção/veterinária , Seringas/veterinária , Animais , Asma/diagnóstico , Lavagem Broncoalveolar/instrumentação , Lavagem Broncoalveolar/métodos , Contagem de Células/veterinária , Endofenótipos , Contagem de Eritrócitos/veterinária , Feminino , Cavalos , Masculino , Estações do Ano , Sucção/métodosAssuntos
Anestesia Endotraqueal/efeitos adversos , Anestesia Geral/efeitos adversos , Fibrose Cística/cirurgia , Hemoptise/terapia , Complicações Intraoperatórias/etiologia , Adulto , Anestesia Endotraqueal/métodos , Anestesia Geral/métodos , Lavagem Broncoalveolar/instrumentação , Lavagem Broncoalveolar/métodos , Broncoscópios , Broncoscopia/instrumentação , Broncoscopia/métodos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Fibrose Cística/complicações , Epinefrina/administração & dosagem , Evolução Fatal , Feminino , Hemoptise/etiologia , Ventilação de Alta Frequência , Humanos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Ressuscitação/métodos , Adulto JovemRESUMO
BACKGROUND: Broncho alveolar lavage (BAL) is widely used for investigative research to study innate, cellular and humoral immune responses, and in early phase drug trials. Conventional (multiple use) flexible bronchoscopes have time and monetary costs associated with cleaning, and carries a small risk of cross infection. Single use bronchoscopes may provide an alternative, but have not been evaluated in this context. METHODS: Healthy volunteers underwent bronchoscopy at a day-case clinical research unit using the Ambu® aScopeTM single-use flexible intubation bronchoscope. Broncho alveolar lavage was performed from a sub segmental bronchus within the right middle lobe; a total of 200 ml of warmed normal saline was instilled then aspirated using handheld suction. BAL volume yield, cell yield and viability were recorded. RESULTS: Ten volunteers, (mean age 23 years, six male) participated. Bronchoscopies were carried out by one of two senior bronchoscopists, experienced in the technique of obtaining BAL for research purposes. The results were compared to 50 (mean age 23, 14 male) procedures performed using the conventional scope by the same two bronchoscopists. The total volume yield was significantly higher in the disposable group median 152 ml (IQR 141-166 ml) as compared to conventional 124 ml (110-135 ml), p = <0.01. The total cell yield and viability were similar in both groups, with no significant differences. CONCLUSIONS: With single use bronchoscopes, we achieved a larger BAL volume yield than conventional bronchoscopes, with comparable cell yield and viability. Better volume yields can potentially reduce post procedure side effects such as pleuritic chest pain and cough. The risk of cross infection can be eliminated, providing reassurance to researchers and participants. Reduced maintenance requirements can be cost effective. These could potentially be used for early phase drug development studies. TRIAL REGISTRATION: This trial was registered prospectively in July 2015 with the National Clinical Trials register, with the following registration number assigned: NCT 02515591 .
Assuntos
Pesquisa Biomédica/instrumentação , Lavagem Broncoalveolar/instrumentação , Broncoscópios , Adulto , Líquido da Lavagem Broncoalveolar/citologia , Sobrevivência Celular , Infecção Hospitalar/prevenção & controle , Equipamentos Descartáveis , Equipamentos Médicos Duráveis , Feminino , Voluntários Saudáveis , Humanos , Masculino , Estudos Prospectivos , Adulto JovemRESUMO
Although culture-independent techniques have refuted lung sterility in health, controversy about contamination during bronchoscope passage through the upper respiratory tract (URT) has impeded research progress. We sought to establish whether bronchoscopic sampling accurately reflects the lung microbiome in health and to distinguish between two proposed routes of authentic microbial immigration, (i) dispersion along contiguous respiratory mucosa and (ii) subclinical microaspiration. During bronchoscopy of eight adult volunteers without lung disease, we performed seven protected specimen brushings (PSB) and bilateral bronchoalveolar lavages (BALs) per subject. We amplified, sequenced, and analyzed the bacterial 16S rRNA gene V4 regions by using the Illumina MiSeq platform. Rigorous attention was paid to eliminate potential sources of error or contamination, including a randomized processing order and the inclusion and analysis of exhaustive procedural and sequencing control specimens. Indices of mouth-lung immigration (mouth-lung community similarity, bacterial burden, and community richness) were all significantly greater in airway and alveolar specimens than in bronchoscope contamination control specimens, indicating minimal evidence of pharyngeal contamination. Ecological indices of mouth-lung immigration peaked at or near the carina, as predicted for a primary immigration route of microaspiration. Bacterial burden, diversity, and mouth-lung similarity were greater in BAL than PSB samples, reflecting differences in the sampled surface areas. (This study has been registered at ClinicalTrials.gov under registration no. NCT02392182.)IMPORTANCE This study defines the bacterial topography of the healthy human respiratory tract and provides ecological evidence that bacteria enter the lungs in health primarily by microaspiration, with potential contribution in some subjects by direct dispersal along contiguous mucosa. By demonstrating that contamination contributes negligibly to microbial communities in bronchoscopically acquired specimens, we validate the use of bronchoscopy to investigate the lung microbiome.
Assuntos
Bactérias/genética , Bactérias/isolamento & purificação , Líquido da Lavagem Broncoalveolar/microbiologia , Pulmão/microbiologia , Metagenoma , Microbiota , Adulto , Idoso , Bactérias/classificação , Lavagem Broncoalveolar/instrumentação , Lavagem Broncoalveolar/normas , Broncoscopia/efeitos adversos , Broncoscopia/normas , DNA Bacteriano/genética , Feminino , Voluntários Saudáveis , Humanos , Masculino , Microbiota/genética , Pessoa de Meia-Idade , Boca/microbiologia , RNA Ribossômico 16S/genética , Análise de Sequência de DNARESUMO
PURPOSE: Stem cell transplant (SCT) recipients commonly undergo bronchoalveolar lavage (BAL) collection as an infectious pulmonary work-up. Previous studies report the utility and overall diagnostic yield of fiberoptic bronchoscopy with BAL in this vulnerable population, though none focused purely on microbiologic yield or made comparisons with less invasive means of pathogen detection. We sought to determine and elaborate on the microbiologic yield of BAL in SCT recipients, assess a correlation between BAL studies and less invasive means of pathogen detection, and assess the utility of repeating a BAL within 30 days. METHODS: Between January 1, 2009, and July 31, 2013, we reviewed medical records of 125 SCT recipients who underwent 179 BALs. In addition to demographic information and details pertaining to their SCT, a comprehensive review of their microbiologic data was performed and recorded. RESULTS: Our study showed an overall BAL microbiologic yield of 40%, despite 92% of patients receiving broad-spectrum antimicrobial therapy at the time of the BAL procedure. CONCLUSIONS: Although an initial BAL sample in this population provides crucial microbiologic information, repeating the procedure within 30 days may have minimal additional microbiologic yield. BAL continues to be an essential diagnostic tool in SCT recipients undergoing an infectious pulmonary work-up.
Assuntos
Antibacterianos/uso terapêutico , Líquido da Lavagem Broncoalveolar/microbiologia , Neoplasias/terapia , Infecções Respiratórias/microbiologia , Transplante de Células-Tronco/efeitos adversos , Adulto , Idoso , Lavagem Broncoalveolar/instrumentação , Lavagem Broncoalveolar/métodos , Broncoscopia/instrumentação , Broncoscopia/métodos , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/prevenção & controle , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Transplante Autólogo/efeitos adversos , Transplante Homólogo/efeitos adversosRESUMO
BACKGROUND: Bronchoalveolar lavage (BAL) may be performed using a hand-held syringe or wall suction. OBJECTIVES: The aim was to study BAL volume and diagnostic yields based on BAL technique. METHODS: A total of 220 consecutive patients undergoing BAL at our center were included. Manual aspiration was performed in 115 patients (group 1), and wall suction (<50 mm Hg of negative pressure) was used in 105 patients (group 2). All bronchoscopies were performed under conscious sedation applying topical anesthesia with lidocaine. Three 50-ml sterile saline aliquots were instilled in all patients. RESULTS: The mean total amount of fluid recovered was 67 ± 20 ml in group 1 and 55 ± 22 ml in group 2 (p < 0.001). More patients in the manual aspiration group met American Thoracic Society criteria (recovery of ≥30% of instilled fluid) for an optimal BAL (81 vs. 59%; p < 0.001). The quantity of recovered fluid was also related to BAL location (p < 0.001) and radiologic findings (p = 0.002). Forty-eight (22%) BALs were diagnostic (23 in group 1 and 25 in group 2), including 37 positive bacterial cultures, 6 positive stains for Pneumocystis, and 5 cases of malignancy. No statistically significant difference in diagnostic yield was observed between the two groups. A BAL diagnosis was more likely in patients with certain radiologic (p = 0.033) and endoscopic findings (p = 0.001). When taking into account all bronchoscopic techniques performed during the procedure (e.g. biopsies, brushing, etc.), bronchoscopy was diagnostic in 37% of patients. CONCLUSIONS: Manual aspiration is superior to wall suction during BAL yielding a larger quantity of aspirate. Diagnostic yields are similar for both techniques.
Assuntos
Lavagem Broncoalveolar/instrumentação , Broncoscopia/instrumentação , Idoso , Lavagem Broncoalveolar/métodos , Lavagem Broncoalveolar/estatística & dados numéricos , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosAssuntos
Lavagem Broncoalveolar/veterinária , Cateterismo/veterinária , Hipnóticos e Sedativos/uso terapêutico , Animais , Bactérias/isolamento & purificação , Lavagem Broncoalveolar/instrumentação , Cateterismo/métodos , Bovinos , Pulmão/microbiologia , Masculino , Resultado do Tratamento , Xilazina/uso terapêuticoAssuntos
Lavagem Broncoalveolar/efeitos adversos , Broncoscopia/efeitos adversos , Infecção por Mycobacterium avium-intracellulare/complicações , Pneumotórax/etiologia , Idoso de 80 Anos ou mais , Dor nas Costas/etiologia , Lavagem Broncoalveolar/instrumentação , Lavagem Broncoalveolar/métodos , Tosse/etiologia , Feminino , Humanos , Derrame Pleural/etiologiaRESUMO
BACKGROUND: Bronchoalveolar lavage (BAL) is a commonly used diagnostic and research tool. Currently, there is limited evidence regarding standardizing this technique. The type of suction method and number of aliquots used as well as the anatomic lung segment sampled are not standardized nor well studied. Our primary aim was to compare the quantity and quality of BAL specimens using 2 suction methods, hand-held syringe versus wall suction. Our secondary aim was to assess which anatomic lung segment yields the greatest BAL results and how many aliquots are required. METHODS: A prospective clinical study was performed in patients undergoing bronchoscopies using hand-held syringe or wall suction. On the basis of radiologic findings, 100 mL (with 4 aliquots) of normal saline was instilled and the percentage volume return calculated. RESULTS: Sixy-six patients were enrolled. Thirty-three patients received hand-held syringe and 33 using wall suction. There was no significant difference in the percentage volume returned, or the adequacy of fluid between these suction methods. When comparing volumes of return from different lobes, greater returns were demonstrated from the right middle lobe (P=0.002). In addition, with each sequential aliquot instilled, the return of fluid was increased significantly (P<0.001). CONCLUSIONS: No significant difference was observed between hand-held syringe and wall suction in terms of volumes returned and microbiological or diagnostic yield. Performance of BAL in the right middle lobe is associated with increased return and should be preferentially used when performing a nontargeted BAL in patients with diffuse computed tomography chest changes.
Assuntos
Lavagem Broncoalveolar/métodos , Pulmão/citologia , Sucção/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lavagem Broncoalveolar/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sucção/instrumentação , Adulto JovemRESUMO
Objective Fibre-optic bronchoscopy with bronchoalveolar lavage (FOB-BAL) is an important tool for diagnosing and selecting treatment for acutely hypoxaemic patients with diffuse lung infiltrates. However, FOB-BAL carries a risk of significant hypoxaemia and subsequent tracheal intubation during and after the procedure. The application of FOB-BAL using a laryngeal mask airway (LMA) in combination with continuous positive airway pressure (CPAP) may minimize the incidence of hypoxaemia; however, the safety and efficacy of this procedure have not been investigated. Methods A retrospective chart review was performed from April to September 2013. Data regarding the recovered volume of BAL fluid, incidence of tracheal intubation within eight hours after the completion of FOB-BAL, respiratory and haemodynamic parameters and treatment modifications were collected for the evaluation. Results Ten trials of FOB-BAL using an LMA and CPAP were performed in nine patients with severe acute hypoxaemia associated with diffuse lung infiltrates. The BAL fluid recovery rate was 56%, and the procedure was completed without subsequent complications. In addition, the percutaneous arterial oxygen saturation decreased to 95.7%±3.8%, although it was never lower than 90.0% during the procedure, and no patients required intubation. Furthermore, the arterial blood pressure significantly but transiently decreased due to sedation, and the procedure yielded diagnostic information in all nine patients. Conclusion FOB-BAL using LMA and CPAP appears to be safe and effective in patients who develop severe acute hypoxaemia.
Assuntos
Lavagem Broncoalveolar/instrumentação , Hipóxia/terapia , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas , Síndrome do Desconforto Respiratório/terapia , Insuficiência Respiratória/terapia , Idoso , Lavagem Broncoalveolar/efeitos adversos , Broncoscopia/métodos , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Tecnologia de Fibra Óptica , Hemodinâmica , Humanos , Hipóxia/etiologia , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Troca Gasosa Pulmonar , Síndrome do Desconforto Respiratório/etiologia , Insuficiência Respiratória/etiologia , Estudos RetrospectivosRESUMO
BACKGROUND: Ventilator-associated pneumonia (VAP) remains a common complication in critically ill surgical patients, and its diagnosis remains problematic. Exhaled breath contains aerosolized droplets that reflect the lung microbiota. We hypothesized that exhaled breath condensate fluid (EBCF) in hygroscopic condenser humidifier/heat and moisture exchanger (HCH/HME) filters would contain bacterial DNA that qualitatively and quantitatively correlate with pathogens isolated from quantitative BAL samples obtained for clinical suspicion of pneumonia. METHODS: Forty-eight adult patients who were mechanically ventilated and undergoing quantitative BAL (n = 51) for suspected pneumonia in the surgical ICU were enrolled. Per protocol, patients fulfilling VAP clinical criteria undergo quantitative BAL bacterial culture. Immediately prior to BAL, time-matched HCH/HME filters were collected for study of EBCF by real-time polymerase chain reaction. Additionally, convenience samples of serially collected filters in patients with BAL-diagnosed VAP were analyzed. RESULTS: Forty-nine of 51 time-matched EBCF/BAL fluid samples were fully concordant (concordance > 95% by κ statistic) relative to identified pathogens and strongly correlated with clinical cultures. Regression analysis of quantitative bacterial DNA in paired samples revealed a statistically significant positive correlation (r = 0.85). In a convenience sample, qualitative and quantitative polymerase chain reaction analysis of serial HCH/HME samples for bacterial DNA demonstrated an increase in load that preceded the suspicion of pneumonia. CONCLUSIONS: Bacterial DNA within EBCF demonstrates a high correlation with BAL fluid and clinical cultures. Bacterial DNA within EBCF increases prior to the suspicion of pneumonia. Further study of this novel approach may allow development of a noninvasive tool for the early diagnosis of VAP.
Assuntos
Testes Diagnósticos de Rotina/métodos , Expiração , Pulmão/microbiologia , Técnicas Microbiológicas/métodos , Microbiota/genética , Pneumonia Associada à Ventilação Mecânica/diagnóstico , Pneumonia Associada à Ventilação Mecânica/microbiologia , Lavagem Broncoalveolar/instrumentação , Lavagem Broncoalveolar/métodos , Estado Terminal , DNA Bacteriano/genética , Testes Diagnósticos de Rotina/instrumentação , Humanos , Unidades de Terapia Intensiva , Técnicas Microbiológicas/instrumentação , Projetos Piloto , Reação em Cadeia da Polimerase em Tempo Real , Análise de Regressão , Sensibilidade e EspecificidadeRESUMO
In recent clinical practice, high-flow nasal cannula (HFNC) therapy has been used to improve oxygenation in adults with acute respiratory failure (ARF). However, bronchoscopy using HFNC in ARF has not yet been reported. Herein, we describe 5 cases of ARF where bronchoalveolar lavage (BAL) was employed successfully using an HFNC. We were able to discontinue or reduce the HFNC fraction of inspired oxygen (FiO2) 30 min after completion of the bronchoscopy. Only 1 patient needed non-invasive positive pressure ventilation for 16 h after bronchoscopy. The HFNC may be a useful tool for ARF patients who require bronchoscopy.