Fiberoptic Flexible Bronchoscopy (FFB) is a safe and widely used tool in the evaluation of pulmonary disorders. There is limited information on the usefulness of TBBx in ICU patients on mechanical ventilation (MV). The goals of the study were:to evaluate indications, complications and yield of FFB with TBBx and bronchoalveolar lavage (BAL) compared with BAL-only in patients on MV in the ICU.
Retrospective review of ICU patients on MV who underwent diagnostic FFB from January 2006 to June 2008. All the TBBx were done without fluoroscopic guidance.
132 patients (92 BAL-only and 40 TBBx plus BAL) were identified; 48 (36%) were HIV+. Mean age was 54-years. The main indication for FFB was evaluation of lung infiltrates (99% cases). There were significantly more HIV infected patients in the TBBX plus BAL group (P 0.002). There were no differences for the overall yield of FFB between the BAL-only versus BAL plus TBBX group (P 0.55). In non-HIV patients, BAL plus biopsy had a better yield for non infectious diseases such as malignancy. In HIV pts there was a higher yield of bacterial infections as compared to non-HIV; however TBBx yielded more non bacterial diagnosis such as PCP and fungal and malignancy.
FFB is a safe and useful diagnostic tool for patients on MV in the ICU. For HIV infected patients although BAL alone is helpful, TBBx may offer incremental diagnosis.
TBBx without fluoroscopy can be performed safely in mechanically ventilated patients in the ICU and can provide additional non bacterial diagnosis. In patients who are too ill for open lung biopsy FFB with BAL and TBBX may be a good alternative.
Jagadish Akella, No Financial Disclosure Information; No Product/Research Disclosure Information