Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

Álvarez-Maldonado, Pablo; Redondo, Carlos Núñez-Pérez; Casillas-Enríquez, José D.; Navarro-Reynoso, Francisco; Cícero-Sabido, Raúl

doi:10.5402/2013/217505

Cited by 10 publications

(8 citation statements)

References 40 publications

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“…The spectrum of BAL fluid microbial isolates obtained from patients admitted to ICU varies across studies. In our study, Acinetobacter baumanii was the commonest bacterial isolate found, and similar results were obtained from studies conducted in ICU settings in Brazil, Mexico, India, and Iran, where one-third or more of the isolates were of Acinetobacter baumanii [ 3 , 8 , 16 – 18 ]. Contrary to this in a study from an Egyptian teaching hospital, the commonest isolate in the ICU setting was Pseudomonas aeruginosa , followed by Acinetobacter [ 2 ].…”

Section: Discussionsupporting

confidence: 89%

Change in Antimicrobial Therapy Based on Bronchoalveolar Lavage Data Improves Outcomes in ICU Patients with Suspected Pneumonia

Chogtu,

Mariya Elenjickal,

Shetty

et al. 2023

Critical Care Research and Practice

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Flexible bronchoscopy (FB) is often performed in critically ill patients with suspected pneumonia. It is assumed that there will be an association with improved outcomes when bronchoalveolar lavage (BAL) data lead to a change in antimicrobial therapy. Methods. This study included a retrospective cohort of intensive care unit (ICU) patients who underwent FB for a diagnosis of suspected pneumonia. The study compared the outcome of patients in whom antimicrobial modification was carried out based on BAL reports versus those in whom it was not carried out. Cases where the procedure could not be completed or had incomplete records were excluded. The FB reports were accessed from the register maintained in the Department of Respiratory Medicine. The demographic details, clinical symptoms, laboratory investigations, and microbiological and radiology reports were recorded. Data on the antmicrobial therapy that the patients received during treatment and the outcome of the treatment were obtained from the case records and noted in the data collection form. Results. Data from a total of 150 patients admitted to the ICU, who underwent FB, were analyzed. The outcomes in the group where antimicrobial modification based on bronchoalveolar lavage (BAL) fluid reports was carried out versus the no-change group were as follows: expired 23, improved 82, unchanged 8 versus expired 12, improved 18, and unchanged 7 ( p = 0.018 ); total duration of ICU stay 13.12 ± 10.61 versus 19.43 ± 13.4 days ( p = 0.012 ); and duration from FB to discharge from ICU 6.33 ± 3.76 days versus 8.46 ± 5.99 ( p = 0.047 ). The median total duration of ICU stay and clinical outcomes were significantly better in the nonintubated patients in whom BAL-directed antimicrobial modification was implemented. Distribution of microorganisms based on BAL reports was as follows: Acinetobacter baumanii 45 (30%), Klebsiella pneumoniae 37 (24.66%), Escherichia coli 9 (6%), and Pseudomonas aeruginosa 9 (6%). Conclusion. A change in antimicrobial therapy based on BAL data was associated with improved outcomes. The commonest bacterial isolate in the BAL fluid was Acinetobacter baumanii.

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Section: Discussionsupporting

confidence: 89%

Change in Antimicrobial Therapy Based on Bronchoalveolar Lavage Data Improves Outcomes in ICU Patients with Suspected Pneumonia

Chogtu,

Mariya Elenjickal,

Shetty

et al. 2023

Critical Care Research and Practice

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“…Sixty-seven percent of the bronchoscopies were requested to improve ventilation through bronchial plug removal. This is much more common than that observed with ICU non-COVID patients-about 25% 5 and could be explained by technical ventilation adaptations related to the pandemic. Usually, during invasive ventilation, warming and moistening of inhaled gases is obtained by the addition of heated humidifiers (HH) or heat-moisture exchangers (HME).…”

mentioning

confidence: 81%

Bronchoscopy in COVID‐19 intensive care unit patients

et al. 2020

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“…In the study by Alvarez-Maldonado et al . that included 102 critical care patients, 65% of the patients are reported to have developed transient hypoxemia during bronchoscopy, while 3.5% developed other minor complications such as bleeding or dysrhythmia ( 19 ). Prebil et al .…”

Section: Discussionmentioning

confidence: 99%

Is Flexible Bronchoscopy a Safe Procedure for Critical Care Patients with Respiratory Failure?

Gürün Kaya

2023

ACC

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SUMMARY Flexible bronchoscopy (FB) plays an important role in critical care patients. But, critical care patients with respiratory failure are at an increased risk of developing complications. Considering the developments in intensive care unit care in recent years, we aimed to evaluate the use of FB in these patients. We retrospectively reviewed patients who underwent FB in critical care between 2014 and 2020. A total of 143 patients underwent FB during the study period. Arterial blood gas measurement on the FB day revealed a mean PaO 2 /FiO 2 of 186.94±28.47. Eighty-one (56.6%) patients underwent an fiberoptic bronchoscopy procedure under conventional oxygen supplementation, 10 (7%) on noninvasive ventilation, 13 (9.1%) on high flow nasal cannula, and 39 (27.3%) on invasive mechanical ventilation. During and immediately after bronchoscopy, none of the patients experienced life-threatening complications. Fifty-five (38.5%) patients developed complications that could be controlled. Multivariate analysis indicated that increased Apache-II score and presence of cardiovascular disease were significantly associated with an increased complication risk. Although critical care patients with respiratory failure are more prone to complications, diagnostic and therapeutic bronchoscopy may be performed following appropriate patient selection, without leading to major complications.

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Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

Cited by 10 publications

References 40 publications

Change in Antimicrobial Therapy Based on Bronchoalveolar Lavage Data Improves Outcomes in ICU Patients with Suspected Pneumonia

Change in Antimicrobial Therapy Based on Bronchoalveolar Lavage Data Improves Outcomes in ICU Patients with Suspected Pneumonia

Bronchoscopy in COVID‐19 intensive care unit patients

Is Flexible Bronchoscopy a Safe Procedure for Critical Care Patients with Respiratory Failure?

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