BAL for pneumonia prevention in tracheostomy patients: A clinical trial study

Vejdan, Seyyed Amir; Khosravi, Maliheh

doi:10.12669/pjms.291.1971

Cited by 7 publications

(7 citation statements)

References 26 publications

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“…Various complications reported include oxygen desaturation (3%–65%), bleeding (2.4%–32.4%), arrhythmias (1.5%–5.7%), bronchospasm (1.9%–8.6%), pneumothorax (1.2%–23.6%), hypotension (2.5%–22%), increased intracranial tension (20%–81%), and death (0.8%–5.4%). [379380384385386388403404405406407408409410411412] In a prospective evaluation of 107 critically ill patients who underwent bronchoscopy (73 on invasive mechanical ventilation, 28 on oxygen, 6 on NIV), 10 patients had reversible cardiorespiratory events and 13 patients had transient desaturation. [380] While performing endobronchial sampling in the ICU, complications such as oxygen desaturation, hemorrhage, arrhythmias, bronchospasm, and pneumothoraces have been reported.…”

Section: Flexible Bronchoscopy In Intensive Care Unit (Icu)mentioning

confidence: 99%

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

et al. 2019

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Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.

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Section: Flexible Bronchoscopy In Intensive Care Unit (Icu)mentioning

confidence: 99%

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

et al. 2019

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“…Previous studies have shown beneficial rule for bronchoscopic suction of secretions in preventing the development of pneumonia; Vejdan and Khosravi demonstrated in their clinical trial that the use of FB and BAL to clear airway secretions in head trauma patients who needed tracheostomy decreased the risk of nosocomial pneumonia from 35 to 14% and can even shorten the ICU stay time. 24 …”

Section: Discussionmentioning

confidence: 99%

Use of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonitis

Megahed¹,

Elmenshawy²,

Ibrahim³

2021

Indian Journal of Critical Care Medicine

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A bstract Background and objectives Aspiration-induced lung injury accounts for a significant proportion of acute pulmonary dysfunction. Few studies were conducted to study the use of early bronchoscopy in mechanically ventilated patients with aspiration pneumonitis. This study aimed at assessing the clinical impact of early bronchoscopy for removal of gastric fluid and solid particles in the first 24 hours of mechanical ventilation (MV) on the progression of aspiration, MV days, intensive care unit (ICU) stay, development of pneumonia, and ICU mortality. Materials and methods The study was an open-label randomized control trial and included 76 adult subjects mechanically ventilated due to aspiration pneumonitis, half the subjects received early bronchoscopy in the first 24 hours after aspiration for removal of aspirated material and bronchoalveolar lavage sampling, the other half received standard treatment. Results The intervention group had a significant reduction in the rate of development of pneumonia at 60.5 vs 81.6%, p = 0.043 through the first week of admission, the intervention group has a significantly better hypoxic index (HI), white blood count, clinical pulmonary infection score, lung injury score, and sepsis-related organ failure assessment (SOFA) score compared to the control group. Although there was a reduction in mechanical ventilation days and ICU mortality in the intervention group vs control group that difference did not reach statistical significance. Conclusions Early bronchoscopy in mechanically ventilated patients with aspiration pneumonitis can be beneficial in improving respiratory functions and decreasing the incidence of development of aspiration pneumonia and may guide the de-escalation of antibiotic therapy. How to cite this article Megahed MM, El-Menshawy AM, Ibrahim AM. Use of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonitis. Indian J Crit Care Med 2021;25(2):146–152.

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“…Similar to the present study, Ellekjaer et al 6 found that prophylactic bronchoscopy provided no benefit in critically ill patients with acute respiratory failure. On the other hand, Vejdan et al 7 reported that the use of prophylactic bronchoscopy and bronchoalveolar lavage significantly reduced the risk of nosocomial pneumonia in tracheostomy patients. Although prophylactic flexible bronchoscopy clearly shows benefit in some situations, it may not always be advisable.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Flexible Bronchoscopy Immediately following Open Airway Reconstruction in Children

Manayan

Haser²,

Shah

et al. 2020

Ann Otol Rhinol Laryngol

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Objectives: Prophylactic flexible bronchoscopy immediately following open airway reconstruction allows for directed clearance of the distal airways, potentially reducing the rate of certain postoperative respiratory complications. In this investigation, we sought to determine if prophylactic flexible bronchoscopy at the conclusion of pediatric open airway reconstruction has any benefit over blind flexible suctioning of the trachea. Methods: A retrospective, single-center study at an urban tertiary care hospital was completed. From January 2010 to April 2013, patients underwent open airway reconstruction, immediately followed by blind flexible suctioning of the trachea for distal airway clearance. From May 2013 through December 2016, sequential patients underwent prophylactic flexible bronchoscopy immediately following airway reconstruction. Results: A total of 29 patients (age: 3.6 months-6.2 years) met inclusion criteria. Sixteen sequential patients underwent simple blind flexible suctioning and 13 sequential patients underwent directed, prophylactic flexible bronchoscopy. Demographics and comorbidities between the groups were equivalent other than slightly older age in the prophylactic bronchoscopy group. All clinical outcomes analyzed were equivalent other than faster time to room air ( P < .002) and a decrease in the number of chest physical therapy sessions ( P < .02) in a subset of patients who did not undergo prophylactic bronchoscopy. Conclusion: This investigation suggests that the use of prophylactic flexible bronchoscopy immediately following open airway reconstruction may not be superior to blind flexible suctioning of the trachea in limiting postoperative pulmonary complications. Further studies of greater power are needed to better elucidate any small differences that may exist between these two interventions.

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BAL for pneumonia prevention in tracheostomy patients: A clinical trial study

Cited by 7 publications

References 26 publications

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

Use of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonitis

Prophylactic Flexible Bronchoscopy Immediately following Open Airway Reconstruction in Children

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