title: Safety and efficacy of bronchoalveolar lavage using a laryngeal mask airway in cases of acute hypoxaemic respiratory failure with diffuse lung infiltrates.
abstract: Objective Fibre-optic bronchoscopy with bronchoalveolar lavage (FOB-BAL) is an important tool for diagnosing and selecting treatment for acutely hypoxaemic patients with diffuse lung infiltrates. However, FOB-BAL carries a risk of significant hypoxaemia and subsequent tracheal intubation during and after the procedure. The application of FOB-BAL using a laryngeal mask airway (LMA) in combination with continuous positive airway pressure (CPAP) may minimize the incidence of hypoxaemia; however, the safety and efficacy of this procedure have not been investigated. Methods A retrospective chart review was performed from April to September 2013. Data regarding the recovered volume of BAL fluid, incidence of tracheal intubation within eight hours after the completion of FOB-BAL, respiratory and haemodynamic parameters and treatment modifications were collected for the evaluation. Results Ten trials of FOB-BAL using an LMA and CPAP were performed in nine patients with severe acute hypoxaemia associated with diffuse lung infiltrates. The BAL fluid recovery rate was 56%, and the procedure was completed without subsequent complications. In addition, the percutaneous arterial oxygen saturation decreased to 95.7%±3.8%, although it was never lower than 90.0% during the procedure, and no patients required intubation. Furthermore, the arterial blood pressure significantly but transiently decreased due to sedation, and the procedure yielded diagnostic information in all nine patients. Conclusion FOB-BAL using LMA and CPAP appears to be safe and effective in patients who develop severe acute hypoxaemia.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Yoko
authors.initials: Y
authors.lastname: Sato
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fukuda
authors.forename: Shinshu
authors.initials: S
authors.lastname: Katayama
authors.forename: Yuya
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Ozaki
authors.forename: Toru
authors.initials: T
authors.lastname: Kotani
mesh_terms: D000368:Aged; D018893:Bronchoalveolar Lavage / Q000009:adverse effects / Q000295:instrumentation*; D001999:Bronchoscopy / Q000379:methods; D045422:Continuous Positive Airway Pressure; D005260:Female; D005336:Fiber Optic Technology; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy*; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011659:Pulmonary Gas Exchange; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies