How safe is non-bronchoscopic bronchoalveolar lavage in critically ill mechanically ventilated children?
OBJECTIVE
To assess the safety of non-bronchoscopic bronchoalveolar lavage (NB-BAL) in critically ill mechanically ventilated children.


METHODS
Paediatric intensive care unit in a tertiary children's hospital.


METHODS
The data from 60 consecutive critically ill mechanically ventilated children who underwent NB-BAL was reviewed from November 1997 to December 1999. PRISM score prior to NB-BAL, observations at the time of NB-BAL and arterial blood gases, oxygenation index (OI), ventilator settings, haemodynamic variables and temperature taken at 1 h before, and 1 and 6 h after NB-BAL, were retrieved from the archived computerised database.


RESULTS
Median age was 7 months (IQR 2.8-43 months) and median weight was 5.5 kg (IQR 4-14 kg). Four (7%) patients exhibited significant immediate complications, requiring escalation of respiratory or haemodynamic support. Forty-two (70%) patients had complete data for calculation of OI; there was no significant change in median OI at 1 and 6 h after NB-BAL. However 5 (12%) of these patients experienced an increase in OI of between 10 and 45 at 1 h post NB-BAL, which returned to baseline at 6 h post NB-BAL. Complications did not correlate with any of the available variables: baseline OI, PRISM score or with deterioration at the time of the procedure, although it was observed that four out of the six patients with baseline OIs of greater than 20 experienced complications.


CONCLUSIONS
Non-bronchoscopic bronchoalveolar lavage in critically ill mechanically ventilated neonates and children is generally a well-tolerated procedure, but for some patients, in whom it was not possible to elucidate predictive factors, complications developed. All patients, particularly those with OIs of greater than 20, require careful monitoring during and after the procedure.
Burmester
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Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom. margivan@hotmail.com
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D001784:Blood Gas Analysis; D018893:Bronchoalveolar Lavage / Q000009:adverse effects*; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012120:Respiration Disorders / Q000097:blood / Q000209:etiology* / Q000401:mortality; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index