Early bronchoalveolar lavage for intubated trauma patients with TBI or chest trauma

J Crit Care. 2017 Jun:39:78-82. doi: 10.1016/j.jcrc.2017.02.010. Epub 2017 Feb 12.

Abstract

Purpose: 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.

Methods: 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 ≥104 organisms on BAL or Clinical Pulmonary Infection Score >6.

Results: 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)).

Conclusions: 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.

Keywords: Antibiotics; Aspiration; Bronchoalveolar lavage; Clinical pulmonary infection score; Pneumonia; Trauma.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Bronchoalveolar Lavage / methods*
  • Female
  • Humans
  • Intensive Care Units
  • Length of Stay
  • Lung Injury / diagnosis
  • Male
  • Middle Aged
  • Pneumonia / diagnosis
  • Retrospective Studies
  • Thoracic Injuries / therapy*

Substances

  • Anti-Bacterial Agents