Fiberoptic Bronchoscopy (FOB), Bronchoalveolar Lavage (BAL), Respiratory Disease
Conditions
Keywords
Respiratory Insufficiency, Respiratory Distress Syndrome, Mechanical Ventilation, COVID-19, Fiberoptic Bronchoscopy (FOB), Bronchoalveolar Lavage (BAL)
Brief summary
Fiberoptic bronchoscopy (FOB) is widely used as a diagnostic or therapeutic procedure in intensive care units. Patients with ARDS or COVID-19 disease often undergoes to these procedures. However, intensive care patients might suffer from serious side effects such as prolonged oxygen desaturation and adverse change in lung compliance and resistance. This study aims to evaluate these changes and determine their impact on patient stability.
Detailed description
Fiberoptic bronchoscopy (FOB) is widely used in intensive care units as a diagnostic or therapeutic procedure. FOB in respiratory failure patients supported by mechanical ventilation may worsen hypoxemia and hypercapnia, therefore FOB requires careful consideration in this patient population. The generally accepted indications for FOB in ventilated patients are removal of retained secretions, resolution of atelectasis and evaluation of hemoptysis. A diagnostic indication is the bronchoalveolar lavage (BAL), to sample the lower respiratory tract without contamination. Studies of FOB performed in mechanically ventilated patients suggest an acceptable safety profile, except for the occurrence of hypoxemia as the main adverse event. Bronchoalveolar Lavage (BAL) in normal volunteers is reported to be safe and does not lead to measurable changes in pulmonary function parameters. However, in intensive care patients may suffer from serious side effects such as prolonged oxygen desaturation. Moreover, reductions in arterial oxygen tension (PaO2) have been reported to persist in some patients for 4 h and more after the procedure. Authors reported the BAL procedure is associated to a worsening of PaO2/FiO2 ratio, in several ARDS patients the drop in PaO2 was higher than 30%. Moreover a physiological study in patients undergoing FOB and BAL showed adverse change in lung compliance and resistance. The purpose of this prospective study is to determine the alterations in respiratory mechanics (regional compliance and resistance) and gas exchange induced by FOB and BAL up to 6 hours after the procedure. The lung regional ventilation evaluation will be made by electrical impedance tomography (EIT).
Interventions
PROCEDUREFiberoptic Bronchoscopy (FOB)
FOB under full sedation (RASS sedation scale -5) and full paralysis.
PROCEDUREBronchoalveolar Lavage (BAL)
BAL under full sedation (RASS sedation scale -5) and full paralysis. Lavage: NaCl 0,9% 50ml x 3 in lung region targetted according to RX/CT scan.
DIAGNOSTIC_TESTElectrical Impedance Tomography (EIT)
Realtime thoracic impedance coupled with ventilation parameters recording.
DIAGNOSTIC_TESTArterial Blood Gas test (ABG)
Multiples Arterial Blood Gas test (ABG) via arterial catheter.
Sponsors
Erasme University Hospital
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Mechanically ventilated ICU patients requiring a FOB or FOB + BAL
Exclusion criteria
* PaO2/FiO2 ratio \<100 * Age \< 18 years * Pregnancy * Unstable angina and recent (less than 1 week) myocardial infarction * Uncontrolled cranial hypertension * Major hemodynamic instability * Any previous lung surgery (except for lung transplantation) * Obesity (BMI \> 50) * Chest circumference \> 150 cm * Electronic implanted device (pacemaker, neurostimulator, etc.) Patients who had undergone several bronchoscopy procedures could not be included twice.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Regional Compliance Variation | From FOB/BAL to 6 hours later | The variation of regional compliance, calculated by electrical impedance |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Regional Compliance and FOB duration | From FOB/BAL to 6 hours later | Relation between regional compliance variation and FOB duration |
| Regional Compliance and PaO2 | From FOB/BAL to 6 hours later | Relation between regional compliance variation and PaO2 variation |
| Atelectasis areas and BAL flooded areas | From FOB/BAL to 6 hours later | Relation between atelectasis impedance-detected areas and BAL flooded impedance-detected areas |
| Regional Resistance Variation | From FOB/BAL to 6 hours later | The variation of regional resistance, calculated by electrical impedance |
| PaCO2 | From FOB/BAL to 6 hours later | Variation of PaCO2 post FOB/BAL |
| Endotracheal tube size and Fiberscope size | From FOB/BAL to 6 hours later | Relation between the endotracheal tube/fiberscope size ratio and gas exchanges |
| Hemodynamic variations | From FOB/BAL to 6 hours later | Heart rate (HR), Blood Pressure (BP) |
| PaO2 and PaO2/FiO2 ratio | From FOB/BAL to 6 hours later | Variation of PaO2 and PaO2/FiO2 ratio post FOB/BAL |
Countries
Belgium
Contacts
Primary ContactFrancesco Ricottilli, MD
Outcome results
None listed