Safety of research bronchoscopy in critically ill patients

Prebil, Sarah E.; Andrews, Joel; Cribbs, Sushma K.; Martin, Greg S.; Esper, Annette

doi:10.1016/j.jcrc.2014.06.006

Cited by 35 publications

(29 citation statements)

References 13 publications

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“…Almost all the patients who were mechanically ventilated had a size 7.5 -8.5 ET tube or had tracheostomy in place. As in prior studies, BAL performed for evaluation of pneumonia and atelectasis were the two most common indications of the procedure (72% and 15.8% respectively) in our study (1)(2)(3)(4)(5)(6)(7). Even though bronchoscopy has not shown to be routinely superior to chest physiotherapy, certain subset of patient population may benefit from it (3,8,9).…”

Section: Discussionsupporting

confidence: 60%

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Safety and complications of bronchoscopy in an adult intensive care unit

Ganesh¹,

Singh²,

Carr³

2015

Southwest J Pulm Crit Care

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Background: Bronchoscopy is a common procedure performed in adult intensive care units (ICU). However, very few studies report the safety and complications of the bronchoscopy and related procedures performed on critically ill patients. The primary aim of this study was to determine the incidence of complications following ICU bronchoscopy. Methods: We conducted a retrospective chart review of patients admitted to an adult ICU and underwent bronchoscopy with or without bronchoalveolar lavage (BAL) and other bronchoscopic procedures. Data included patient demographics, APACHE II score, hemodynamics, comorbidities, type of ventilation and procedure performed. Data from BAL, including cellular differential and microbiology, were also collected.

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Section: Discussionsupporting

confidence: 60%

“…Most prior studies reporting the safety of bronchoscopy were performed in early 1990s. The rates of complications or adverse events in these earlier studies ranged from 2% to 40% (2,(4)(5)(6). The primary aim of this study was to assess the incidence of complications in ICU patients undergoing bronchoscopy in the contemporary era.…”

Section: Introductionmentioning

confidence: 99%

Safety and complications of bronchoscopy in an adult intensive care unit

Ganesh¹,

Singh²,

Carr³

2015

Southwest J Pulm Crit Care

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“…Finally, NBBAL is safe. Our consecutive series of over 1,000 NBBAL procedures demonstrated favorable complication rates, which are lower than the reported complication rates of bronchoscopic BALs performed for research purposes in critically ill patients (17).…”

Section: Discussionmentioning

confidence: 54%

Multidimensional assessment of alveolar T cells in critically ill patients

Walter¹,

Helmin²,

Abdala‐Valencia³

et al. 2018

JCI Insight

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Pneumonia represents the leading infectious cause of death in the United States. Foxp3+ regulatory T cells promote recovery from severe pneumonia in mice, but T cell responses in patients with pneumonia remain incompletely characterized because of the limited ability to serially sample the distal airspaces and perform multidimensional molecular assessments on the small numbers of recovered cells. As T cell function is governed by their transcriptional and epigenetic landscape, we developed a method to safely perform high-resolution transcriptional and DNA methylation profiling of T cell subsets from the alveoli of critically ill patients. Our method involves nonbronchoscopic bronchoalveolar lavage combined with multiparameter fluorescence-activated cell sorting, unsupervised low-input RNA-sequencing, and a modified reduced-representation bisulfite sequencing protocol. Here, we demonstrate the safety and feasibility of our method and use it to validate functional genomic elements that were predicted by mouse models. Because of its potential for widespread application, our techniques allow unprecedented insights into the biology of human pneumonia.

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“…Although there was a high prevalence of PCP in HIV/AIDS patients with advanced immunosuppression (25.4% in European and 23-31% in USA) [4,7], most PCP cases were clinically diagnosed without microbiology evidence in the world, even in the developed countries [8,9], because of the difficulty of pulmonary specimens acquisition and pneumocystis culture [10][11][12]. Subacute onset of fever, dry cough and exertional dyspnea are usually the main symptoms of PCP, accompanied by typical bilateral GGO with or without cystic lesions on chest computed tomography (CT) scans, which is used as a basis for presumptive diagnosis of PCP.…”

Section: Discussionmentioning

confidence: 99%

The outcome predictors and therapeutic strategy of pneumocystis pneumonia in North China: a double-center retrospective study

Yang

Zhang³

et al. 2019

Preprint

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Background: Pneumocystis pneumonia (PCP) is common in HIV/AIDS patients with advanced immunosuppression. Trimethoprim/sulfamethoxazole (TMP/SMX) is recommended as the first-line anti-pneumocystis agent as soon as PCP is suspected based on its typical feature. However, the clinical characteristic and therapeutic strategy of Chinese PCP were not well-known. Methods: We retrospectively investigated 473 HIV associated PCPs in North China from double centers, Beijing You An Hospital during 2010 to 2017 and the Infectious Disease Hospital in Harbin during 2015 to 2017. HIV associated PCP were diagnosed as the guideline recommended by CDC, NIH and HIV Medicine Association of IDSA. Demographic and clinic data were collected and statistically analysed as the parameter distribution feature. Results: Among 473 HIV associated PCPs, we found that men were over-represented in PCP due to the high incidence of HIV infection among male homosexuality, and over one-third of them were aware of their HIV infection ago but did not maintain effective antiretroviral therapy. A history of smoking and multi-organism infection or system infection were common among them. In the multivariate analysis, we found lactate dehydrogenase (LDH) (OR 1.020, 95% CI 1.006-1.033, P=0.005), alveolar-arterial O2 difference ([A-a] DO2) and neutrophils counts (OR 1.051, 95% CI 1.005-1.099, P=0.030) were unfavourable predictors and CD4 cell counts (OR 0.900, 95% CI 0.813-0.996, P=0.041) were favourable predictor of PCP outcome. Trimethoprim/sulfamethozole (TMP/SMZ) but not TMP/SMX was used to anti-pneumocystis therapy in these patients with a low side-effect incidence which mainly forcused on epispasis, fever, liver injury and myelosuppression. Caspofungin was the only alternative medicine for those presented poor efficacy or could not tolerate the side-effects of TMP-SMZ and near 30 percent of moderate/severe PCP received glucocorticoid treatment. Conclusion: The present data suggest that high levels of serum-LDH, [A-a] DO2 and neutrophils counts and low CD4 cell counts predict poor outcome of PCP. TMP/SMZ can cure most PCPs with a low side-effect incidence and caspofungin is an effective alternation. A larger prospective study is needed to obtain better estimates of PCP in China.

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Safety of research bronchoscopy in critically ill patients

Cited by 35 publications

References 13 publications

Safety and complications of bronchoscopy in an adult intensive care unit

Safety and complications of bronchoscopy in an adult intensive care unit

Multidimensional assessment of alveolar T cells in critically ill patients

The outcome predictors and therapeutic strategy of pneumocystis pneumonia in North China: a double-center retrospective study

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