PURPOSE: Bronchoscopic bronchoalveolar lavage(B-BAL) and non-bronchoscopic BAL(NB-BAL) procedures are commonly used for diagnosing pneumonia and sepsis in critically ill myelosuppressed cancer patients. There is concern that the BAL procedure is associated with complications, in particular bleeding. Available guidelines for platelet triggers do not address safe platelet levels for BAL procedures. A platelet count of <50 K/UL has been commonly used as a trigger for platelet transfusion for invasive procedures. We studied the platelet levels and complications related to BAL procedures in our oncological intensive care unit (ICU).
METHODS: Following IRB approval, medical records of all adult ICU patients who underwent a BAL procedure between 8/1/2006 and 10/31/2006 were retrospectively studied. B-BAL was performed by physicians and NB-BAL was performed by respiratory therapist (RT) according to departmental policy using 16 Fr Kimberly Clark's protected BAL catheter. The lowest acceptable platelet count for RT performed NB-BAL was 20 K/UL.
RESULTS: A total of 115 patients (solid tumor 66%, hematological malignancies 46%) underwent BAL procedures between 8/1/2006 and 10/31/2006. B-BAL was performed in 59 (51%), NB-BAL in 42 (37%) and both B-BAL and NB-BAL in 14 (12%). The median platelet level in B-BAL group was 104 (Range 5–731) and in NB-BAL was 123 (Range 23–429). There were 24 (33%) in the B-BAL and 10 (18%) in the NB-BAL group who had platelet counts <50 K/UL. The platelet count was <30 K/UL in 15(21%)in B-BAL group and 4 (7%) in NB-BAL group. The procedure was well tolerated by all patients in the B-BAL group. There was only one complication (hypotension) reported in the NB-BAL group and this patient had a platelet count of 202 K/UL. No procedure related bleeding complications were noted in either group.
CONCLUSION: Despite thrombocytopenia, no major adverse events including bleeding was noted in this patient population.
CLINICAL IMPLICATIONS: Physician performed B-BAL and RT performed NB-BAL procedures can be safely done in critically ill cancer patients with thrombocytopenia. A structured guideline and policy is important for RT led procedures.
DISCLOSURE: Shubhra Ghosh, No Financial Disclosure Information; No Product/Research Disclosure Information