Changes in pulmonary mechanics after fiberoptic bronchoalveolar lavage in mechanically ventilated patients

Abstract

BAL in mechanically ventilated patients is associated with deterioration of pulmonary mechanics and function.

Effects of bronchoalveolar lavage volume on arterial oxygenation in mechanically ventilated patients with pneumonia

“…This may result in transient hypoventilation and derecruitment of alveolar space, especially when the peak ventilation pressure is exceeded and the respiratory cycle has to be aborted. In addition, Klein and coworkers described a deterioration in pulmonary compliance after fiberoptic BAL that may further impair gas exchange [26]. It is therefore necessary to repeat our study with blind methods to find out whether differences in arterial oxygenation between high and low BAL volumes have been obscured by the effects of a bronchoscopic procedure in our study.…”

The effect of fibreoptic bronchoscopy in acute respiratory distress syndrome: experimental evidence from a lung model

“…Flexible fibreoptic bronchoscopy is an effective technique for bronchial toilet and diagnosis when ventilator-associated pneumonia is suspected, particularly in cases of ARDS. However, the insertion of a flexible bronchoscope into the tracheal tube of a patient with severe ARDS may have life-threatening consequences, such as pneumothorax [5] or hypoxaemia [12,13]. Indeed, the level of risk may tip the balance between benefit and harm, and this procedure is sometimes avoided in severely ill patients.…”

British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE

“…In a specific study with a specific subgroup of patients with ARDS, a more than 30% drop in PaO 2 was observed in 35% of patients 271. A more detailed physiological study in 18 patients undergoing bronchoscopy and BAL has demonstrated adverse change in lung compliance and resistance 267. Post-bronchoscopy pneumothorax has been reported in ventilated patients in whom transbronchial biopsy was not undertaken 246 264…”