title: Safety of research bronchoscopy in critically ill patients.
abstract: OBJECTIVE
  Bronchoscopy and bronchoalveolar lavage (BAL) are common procedures in intensive care units; however, no contemporaneous safety and outcomes data have been reported, particularly for critically ill patients.
  
  
  METHODS
  This is a retrospective analysis of prospectively collected data from teaching hospital adult intensive care units.
  
  
  METHODS
  One hundred mechanically ventilated patients with severe sepsis, septic shock, acute lung injury (ALI), and/or acute respiratory distress syndrome underwent bronchoscopy with unilateral BAL. Data collected included demographics, presence of sepsis or ALI, Pao2 to Fio2 ratio, positive end-expiratory pressure, Acute Physiology and Chronic Health Evaluation score, Sequential Organ Failure Assessment score, and peri- or postprocedural complications.
  
  
  RESULTS
  Men comprised 51% of the patients; 81% of the patients were black, and 15% were white. The mean age was 52 (SD, ±16) years. The mean Acute Physiology and Chronic Health Evaluation score was 22 (±7.5), whereas the median Sequential Organ Failure Assessment score was 9 (interquartile range, 5-12). Ten patients (10%) had complications during or immediately after the procedure. Hypoxemia during or immediately after the BAL was the most common complication. Ninety percent of the complications were related to transient hypoxemia, whereas bradycardia and hypotension each occurred in 1 patient. Age, female sex, and higher positive end-expiratory pressure were associated with complications.
  
  
  CONCLUSIONS
  Bronchoscopy with BAL in critically ill patients with sepsis and ALI is well tolerated with low risk of complications, primarily related to manageable hypoxemia.
authors.affiliation: University of Minnesota, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Minneapolis, MN.
authors.forename: Sarah E W
authors.initials: SE
authors.lastname: Prebil
authors.affiliation: Emory University, Division of Pulmonary, Allergy and Critical Care Medicine, Atlanta, GA.
authors.forename: Joel
authors.initials: J
authors.lastname: Andrews
authors.affiliation: Emory University, Division of Pulmonary, Allergy and Critical Care Medicine, Atlanta, GA; Pulmonary Medicine, Department of Veterans Affairs Medical Center, Atlanta, GA.
authors.forename: Sushma K
authors.initials: SK
authors.lastname: Cribbs
authors.affiliation: Emory University, Division of Pulmonary, Allergy and Critical Care Medicine, Atlanta, GA.
authors.forename: Greg S
authors.initials: GS
authors.lastname: Martin
authors.affiliation: Emory University, Division of Pulmonary, Allergy and Critical Care Medicine, Atlanta, GA. Electronic address: aesper@emory.edu.
authors.forename: Annette
authors.initials: A
authors.lastname: Esper
mesh_terms: D018806:APACHE; D055371:Acute Lung Injury / Q000150:complications*; D000328:Adult; D000368:Aged; D018893:Bronchoalveolar Lavage / Q000009:adverse effects / Q000379:methods; D001999:Bronchoscopy / Q000009:adverse effects* / Q000379:methods; D016638:Critical Illness; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012189:Retrospective Studies; D012449:Safety; D012737:Sex Factors; D012772:Shock, Septic / Q000150:complications*
keywords: Bronchoalveolar lavage; Bronchoscopy; Complications; Critically ill; Mechanically ventilated
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