The significance of bronchoalveolar or bronchial lavage in ARDS: Validation in 180 patients

Hisanaga, Jumpei; Kawamura, Kodai; Yoshioka, Masakazu

doi:10.1183/13993003.congress-2015.pa823

Cited by 4 publications

(4 citation statements)

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“…BALs usually provide quantification and differential profiles of recoverable free cells of distal airways, and most importantly, adequate material for microbiological cultures [30]. Inflammatory cytokines can also be quantified and pro- to anti-inflammatory balance evaluated, with regards to lung repair, although the clinical relevance of this information is yet to be determined [31,32]. Unfortunately, although a safe procedure in skilled hands [33], BALs in ARDS patients do not always generate useful microbiological results, nor do they often discriminate between different cell distribution profiles [34].…”

Section: Evaluation Of Lung Repair In Ards: Clinical Settingsmentioning

confidence: 99%

In Vivo Endomicroscopy of Lung Injury and Repair in ARDS: Potential Added Value to Current Imaging

Lesur

Chagnon

Lebel

et al. 2019

JCM

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Background: Standard clinical imaging of the acute respiratory distress syndrome (ARDS) lung lacks resolution and offers limited possibilities in the exploration of the structure–function relationship, and therefore cannot provide an early and clear discrimination of patients with unexpected diagnosis and unrepair profile. The current gold standard is open lung biopsy (OLB). However, despite being able to reveal precise information about the tissue collected, OLB cannot provide real-time information on treatment response and is accompanied with a complication risk rate up to 25%, making longitudinal monitoring a dangerous endeavor. Intravital probe-based confocal laser endomicroscopy (pCLE) is a developing and innovative high-resolution imaging technology. pCLE offers the possibility to leverage multiple and specific imaging probes to enable multiplex screening of several proteases and pathogenic microorganisms, simultaneously and longitudinally, in the lung. This bedside method will ultimately enable physicians to rapidly, noninvasively, and accurately diagnose degrading lung and/or fibrosis without the need of OLBs. Objectives and Methods: To extend the information provided by standard imaging of the ARDS lung with a bedside, high-resolution, miniaturized pCLE through the detailed molecular imaging of a carefully selected region-of-interest (ROI). To validate and quantify real-time imaging to validate pCLE against OLB. Results: Developments in lung pCLE using fluorescent affinity- or activity-based probes at both preclinical and clinical (first-in-man) stages are ongoing—the results are promising, revealing correlations with OLBs in problematic ARDS. Conclusion: It can be envisaged that safe, high-resolution, noninvasive pCLE with activatable fluorescence probes will provide a “virtual optical biopsy” and will provide decisive information in selected ARDS patients at the bedside.

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Section: Evaluation Of Lung Repair In Ards: Clinical Settingsmentioning

confidence: 99%

In Vivo Endomicroscopy of Lung Injury and Repair in ARDS: Potential Added Value to Current Imaging

Lesur

Chagnon

Lebel

et al. 2019

JCM

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“…BAL is a safe procedure in non-critically ill patients while the complications are mostly self-limiting [1]. Patients with acute respiratory distress syndrome have a potentially increased risk for complications but, supported by noninvasive ventilation, BAL can demonstrate a feasible tool to circumvent a lung biopsy or resection [2][3][4][5][6]. Microbiological analyses and differential cell counts in BAL samples may provide essential information in complex cases of pneumonia [7].…”

Section: Introductionmentioning

confidence: 99%

Differential Gene Expression of SARS-CoV-2 Positive Bronchoalveolar Lavages: A Case Series

Haslbauer¹,

Prince²,

Stalder³

et al. 2023

Pathobiology

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Transcriptomic data on bronchoalveolar lavage (BAL) from COVID-19 patients are currently scarce. This case series seeks to characterize the intraalveolar immunopathology of COVID-19. BALs were performed on 14 patients (5 COVID-19, of which 3 mild and 2 largely asymptomatic, 9 controls). Controls included asthma (n=1), unremarkable BALs (n=3), infections with respiratory syncytial virus (n=1), influenza B (n=1), and infections with other coronaviruses (n=3). SARS-CoV-2 RNA load was measured by quantitative nucleic acid testing (QNAT), while the detection of other pathogens was performed by immunofluorescence or multiplex NAT. Gene expression profiling was subsequently performed, showing 71 significantly downregulated and 5 upregulated transcripts in SARS-CoV-2-positive lavages versus controls. Downregulated transcripts included genes involved in macrophage development, polarization and crosstalk (LGALS3, MARCO, ERG2, BTK, RAC1, CD83), and genes involved in chemokine signaling and immunometabolism (NUPR1, CEBPB, CEBPA, PECAM1, CCL18, PPARG, ALOX5, ALOX5AP). Upregulated transcripts featured genes involved in NK-T cell signaling (GZMA, GZMH, GNLY, PRF1, CD3G). Patients with mild COVID-19 showed a significant upregulation of genes involved in blood mononuclear cell/leukocyte function (G0S2, ANXA6, FCGR2B, ADORA3), coagulation (VWF), interferon response (IFRD1, IL12RB2) and a zinc metalloprotease elevated in asthma (CPA3) compared to asymptomatic cases. In-silico comparison of the 5 COVID-19 BAL cases to a published cohort of lethal COVID-19 showed a significant upregulation of “antigen processing and presentation” and “lysosome” pathways in lethal cases. These data underscore the heterogeneity of immune response in COVID-19. Further studies with a larger dataset are required to gain a better understanding of the hallmarks of SARS-CoV-2 immunological response.

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“…Bronchoscopic examination is a critical procedure for confirmatory diagnosis and treatment decision-making in patients with lung disease, especially those with acute respiratory failure (ARF). Hisanaga et al reported that bronchoalveolar lavage (BAL) could be beneficial in the management of patients with acute respiratory distress syndrome [1] . However, no in-depth clinical studies have investigated the optimal method of bronchoscopy in patients with ARF because of the challenges involved in performing bronchoscopy in patients with unstable respiratory status.…”

Section: Introductionmentioning

confidence: 99%

“…Hisanaga et al reported that bronchoalveolar lavage (BAL) could be beneficial in the management of patients with acute respiratory distress syndrome. [1] However, no in-depth clinical studies have investigated the optimal method of bronchoscopy in patients with ARF because of the challenges involved in performing bronchoscopy in patients with unstable respiratory status. The British Thoracic Society guideline recommends oxygen supplementation in patients with a significant change in arterial oxygen saturation or with respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Jackson mask ventilation during bronchoscopy in patients with acute respiratory failure

Takumida

Suzuki

et al. 2021

Medicine

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Bronchoscopy is a procedure for diagnosis and treatment decision-making in patients with lung disease, especially those with acute respiratory failure. However, the optimal bronchoscopic method for patients with acute respiratory failure is not known. Therefore, in the real world, we sometimes hesitate to perform bronchoscopy in such patients because of safety and have experienced treating patients without bronchoscopy. To address this problem, we evaluated the usefulness and safety of Jackson mask ventilation, a novel noninvasive method of bronchoscopy performed under mask ventilation using the Jackson Rees circuit, in patients with acute respiratory failure.We retrospectively reviewed patients with acute respiratory failure who underwent bronchoscopy at our institution between January 2015 and May 2018. We compared patients who received Jackson mask ventilation (Jackson group) and those who received conventional oxygen administration (conventional group). Mean percutaneous oxygen saturation (SpO 2 ) and mean oxygen flow rate were compared between the groups by the Wilcoxon signed-rank test. We excluded patients who were intubated and those without acute respiratory failure who received Jackson mask ventilation preventively.Of 1262 patients who underwent bronchoscopy, 12 were classified into the Jackson group and 13 into the conventional group. Proper oxygenation was maintained in the Jackson group, with SpO 2 increasing after Jackson mask ventilation (89.4% to 96.8%, P = .03). Mean SpO 2 was significantly higher in the Jackson group than in the conventional group (96.8% vs 95.2%, P = .03). Mean oxygen flow rate was significantly lower in the Jackson group (4.0 L/min vs 7.9 L/min, P < .001). There was no significant difference in safety.Our findings suggest that Jackson mask ventilation is safe and effective when performing bronchoscopy in patients with acute respiratory failure. Jackson mask ventilation maintained proper oxygenation and decreased the oxygen flow rate compared with the conventional method. Using Jackson mask ventilation, we could perform bronchoscopy safely and effectively in patients with acute respiratory failure, including some who had unstable respiratory status. (UMIN000038481).

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The significance of bronchoalveolar or bronchial lavage in ARDS: Validation in 180 patients

Cited by 4 publications

References 0 publications

In Vivo Endomicroscopy of Lung Injury and Repair in ARDS: Potential Added Value to Current Imaging

In Vivo Endomicroscopy of Lung Injury and Repair in ARDS: Potential Added Value to Current Imaging

Differential Gene Expression of SARS-CoV-2 Positive Bronchoalveolar Lavages: A Case Series

Usefulness of Jackson mask ventilation during bronchoscopy in patients with acute respiratory failure

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