Benefit-to-risk balance of bronchoalveolar lavage in the critically ill. A prospective, multicenter cohort study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2020-01-07

AUTHORS

Toufik Kamel, Julie Helms, Ralf Janssen-Langenstein, Achille Kouatchet, Antoine Guillon, Jeremy Bourenne, Damien Contou, Christophe Guervilly, Rémi Coudroy, Marie Anne Hoppe, Jean Baptiste Lascarrou, Jean Pierre Quenot, Gwenhaël Colin, Paris Meng, Jérôme Roustan, Christophe Cracco, Mai-Anh Nay, Thierry Boulain, Charlotte Salmon-Gandonniere, Stephan Ehrmann, Emmanuelle Mercier, Julien Grouille, Pierre-François Dequin, Walid Darwiche, Denis Garot, Marlene Morisseau, Laetitia Bodet Contentin, Francis Schneider, Vincent Castelain, Max Guillot, Vivien Danielo, Jean Etienne Herbrecht, Quentin Maestraggi, Marie Line Harlay, Baptiste Michard, Maleka Schenck, Florence Fagot Gandet, Guillaume Morel, Vincent Souday, Marc Pierrot, Nicolas Lerolle, Satar Morttaza, Raphaël Clere-Jehl, Hamid Merdji, Ferhat Meziani, Laurent Papazian, Jean Marie Forel, Sami Hraiech, Melanie Adda, Karima Baraka, Florence Daviet, Jo-Anna Tirolien, Gaëtan Plantefeve, Olivier Lesieur, Maxime Leloup, Jean Reignier, Charlotte Garret, Anthony Lemeur, Isabelle Vinatier, David Schnell, Nicolas Bercault, Dalila Benzekri-Lefevre, Grégoire Muller, Anne Bretagnol, Armelle Mathonnet, Marie Skarzynski, Isabelle Runge, François Barbier, Sophie Jacquier

ABSTRACT

PURPOSE: To assess the benefit-to-risk balance of bronchoalveolar lavage (BAL) in intensive care unit (ICU) patients. METHODS: In 16 ICUs, we prospectively collected adverse events during or within 24 h after BAL and assessed the BAL input for decision making in consecutive adult patients. The occurrence of a clinical adverse event at least of grade 3, i.e., sufficiently severe to need therapeutic action(s), including modification(s) in respiratory support, defined poor BAL tolerance. The BAL input for decision making was declared satisfactory if it allowed to interrupt or initiate one or several treatments. RESULTS: We included 483 BAL in 483 patients [age 63 years (interquartile range (IQR) 53-72); female gender: 162 (33.5%); simplified acute physiology score II: 48 (IQR 37-61); immunosuppression 244 (50.5%)]. BAL was begun in non-intubated patients in 105 (21.7%) cases. Sixty-seven (13.9%) patients reached the grade 3 of adverse event or higher. Logistic regression showed that a BAL performed by a non-experienced physician (non-pulmonologist, or intensivist with less than 10 years in the specialty or less than 50 BAL performed) was the main predictor of poor BAL tolerance in non-intubated patients [OR: 3.57 (95% confidence interval 1.04-12.35); P = 0.04]. A satisfactory BAL input for decision making was observed in 227 (47.0%) cases and was not predictable using logistic regression. CONCLUSIONS: Adverse events related to BAL in ICU patients are not infrequent nor necessarily benign. Our findings call for an extreme caution, when envisaging a BAL in ICU patients and for a mandatory accompaniment of the less experienced physicians. More... »

PAGES

463-474

Journal

TITLE

Intensive Care Medicine

ISSUE

3

VOLUME

46

Author Affiliations

  • Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d’Orléans, 14 Avenue de l’Hôpital CS 86709, 45067 Orléans Cedex 2, France
  • CHU de Strasbourg-Hôpital Civil, Service de Réanimation Médicale 1, Place de l’Hôpital, BP 426, 67091 Strasbourg Cedex, France
  • Médecine intensive Réanimation, Hôpital de Haute pierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67098 Strasbourg Cedex, France
  • CHU d’Angers Service de Réanimation Médicale et de Médecine Hyperbare, 4, Rue Larrey, 49933 Angers Cedex 09, France
  • CHRU de Tours-Hôpital Bretonneau Service de Réanimation Polyvalente, 2 bis, Boulevard Tonnelle, 37044 Tours Cedex 09, France
  • Médecine Intensive Réanimation, Réanimation des Urgences CHU la Timone 2-Pole RUSH, 264 Rue Saint Pierre, 13005 Marseille, France
  • CH d’Argenteuil Service de Réanimation Polyvalente, 69, Rue du Lieutenant-Colonel Prudhon, 95107 Argenteuil Cedex, France
  • Aix-Marseille Université, Faculté de médecine, Centre d’Etudes et de Recherches sur les Services de Santé et qualité de vie, EA 3279, 13005 Marseille, France
  • INSERM U1402, Groupe ALIVE, Université de Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France
  • CH de La Rochelle-Hôpital Saint-Louis Service de Réanimation Polyvalente, Rue du Docteur Schweitzer, 17019 La Rochelle Cedex 01, France
  • Service de Médecine Intensive Réanimation, CHU de Nantes-Hôtel Dieu, 30 Bd. Jean Monnet, 44093 Nantes Cedex 1, France
  • CHU de Dijon-Complexe du Bocage, Service de Réanimation Médicale, 2 Boulevard Maréchal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex, France
  • CHD Vendée-Hôpital de la Roche-sur-Yon, Service de Réanimation Polyvalente Les Oudairies, 85925 La Roche-Sur-Yon Cedex 09, France
  • Hôpital Raymond Poincaré, APHP, Service de Médecine intensive Réanimation, 104 Boulevard Raymond Poincaré, 92380 Garches, France
  • Centre hospitalier de Montauban, service de réanimation polyvalente, 100 rue Léon Cladel, BP 765, 82013 Montauban Cedex, France
  • CH d’Angoulême Service de Réanimation Polyvalente, Rond-Point de Girac CS, 55015 Saint-Michel, 16959 Angoulême Cedex 9, France
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00134-019-05896-4

    DOI

    http://dx.doi.org/10.1007/s00134-019-05896-4

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1123926739

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/31912201


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