title: Early bronchoalveolar lavage for intubated trauma patients with TBI or chest trauma.
abstract: To evaluate the efficacy of an early bronchoalveolar lavage (E-BAL) protocol. BAL was performed within 48 h for intubated patients with traumatic brain injury or chest trauma. We hypothesized that E-BAL would decrease antibiotic use and improve outcomes compared to late BAL (L-BAL) triggered by clinical signs of pneumonia.
  
  
  
  Retrospective cohort analysis of 132 patients with quantitative BAL and ≥1 risk factor: head Abbreviated Injury Score ≥2, ≥3 rib fractures, or radiographic signs of aspiration or pulmonary contusion. E-BAL (n=71) was compared to L-BAL (n=61). Pneumonia was defined as ≥104organisms on BAL or Clinical Pulmonary Infection Score >6.
  
  
  
  There were no significant differences in age, injury severity, initial Pao2:Fio2, or smoking status between E-BAL and L-BAL groups. 52% and 61% of the E-BAL and L-BAL cultures were positive, respectively. E-BAL patients had fewer antibiotic days (7.3 vs 9.2, P=.034), ventilator days (11 vs 15, P=.002), tracheostomies (49% vs 75%, P=.002), and shorter intensive care unit and hospital length of stay (13 vs 17 days (P=.007), 18 vs 22 days (P=.041)).
  
  
  
  More than half of all E-BAL patients had pneumonia present early after admission. E-BAL was associated with fewer days on antibiotics and better outcomes than L-BAL.
authors.affiliation: Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Tyler.Loftus@surgery.ufl.edu.
authors.forename: Tyler J
authors.initials: TJ
authors.lastname: Loftus
authors.affiliation: Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: lemosj@shands.ufl.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Lemon
authors.affiliation: Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: linda.nguyen@ufl.edu.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Nguyen
authors.affiliation: Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: svoils@cop.ufl.edu.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Voils
authors.affiliation: Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Scott.Brakenridge@surgery.ufl.edu.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Brakenridge
authors.affiliation: Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Janeen.Jordan@surgery.ufl.edu.
authors.forename: Janeen R
authors.initials: JR
authors.lastname: Jordan
authors.affiliation: Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Chasen.Croft@surgery.ufl.edu.
authors.forename: Chasen A
authors.initials: CA
authors.lastname: Croft
authors.affiliation: Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Steve.Smith@surgery.ufl.edu.
authors.forename: R Stephen
authors.initials: RS
authors.lastname: Smith
authors.affiliation: Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Frederick.Moore@surgery.ufl.edu.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
authors.affiliation: Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Philip.Efron@surgery.ufl.edu.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Efron
authors.affiliation: Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Alicia.Mohr@surgery.ufl.edu.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Mohr
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018893:Bronchoalveolar Lavage / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D055370:Lung Injury / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Aspiration; Bronchoalveolar lavage; Clinical pulmonary infection score; Pneumonia; Trauma