SAFETY OF BRONCHOALVEOLAR LAVAGE IN THE CRITICALLY ILL, MECHANICALLY VENTILATED PATIENT

Objective: To assess complications of bronchoalveolar lavage in the intubated, mechanically ventilated patient. Design: A retrospective, consecutive case series. Setting: Medical, surgical, and bone marrow transplant critical care units at a university teaching hospital. Patients: Ninety-nine consecutive critically ill, mechanically ventilated patients undergoing bronchoalveolar lavage were included in the study. Interventions: All patients underwent bronchoalveolar lavage using a standard method designed to maximize the safety of the procedure. Measurements: Each patient's hospital chart was reviewed for immediate and delayed medical complications of the procedure, including cardiac arrhythmias, bleeding, and hemodynamic disturbances. Specific indices of lung mechanics (peak inspiratory airway pressure and static compliance) and oxygenation (alveolar to arterial oxygen tension gradient [P(A-a)O2] and the ratio of FIO2/PaO2) were measured before and 4 hrs after bronchoalveolar lavage to assess durable physiologic consequences of the procedure. Results: No complications occurred that required premature termination of bronchoalveolar lavage. Three patients exhibited adverse effects (hypotension in two and wheezing in one) immediately after the procedure, all of which resolved promptly with treatment. No statistically significant changes were observed in the variables of arterial oxygenation or pulmonary mechanics. Although the sample mean did not change significantly for any of the oxygen variables, 19% of the patients experienced widening of the P(A-a)O2 by > 100 torr (> 13.3 kPa). A systematic analysis indicated that there was no statistically significant relationship between readily available clinical variables (including duration of mechanical ventilation before bronchoalveolar lavage and prebronchoalveolar lavage P[A-a]O2), and deterioration in oxygenation after the procedure. Conclusions: We conclude that bronchoalveolar lavage is a well-tolerated procedure in critically ill, mechanically ventilated patients, provided that risk factors for complications are corrected before the procedure and one adheres to procedural guidelines focused on patient safety. Clinically important complications are uncommon. Some patients exhibit deterioration in oxygen after bronchoalveolar lavage; this occurrence cannot be predicted before the procedure.