2010 OPEN FORUM Abstracts
NON-BRONCHOSCOPIC BRONCHIAL ALVEOLAR LAVAGE A SAFE AND USEFUL PROCEDURE AS A DIAGNOSTIC AND PREVENTATIVE TOOL AGAINST VENTILATOR-ASSOCIATED PNEUMONIA.
Cherian K. Paily, Richard Wunderink, Sherif Afifi, Robert Gould, Craig Leonard, Nicole Willis; Respiratory Care, Northwestern Memorial Hospital, Chicago, IL
BACKGROUND Accurate diagnosis of Ventilator-associated Pneumonia (VAP) is critical for optimal treatment. Endotracheal aspirates (ETA) often give false positive VAP diagnoses. Bronchoalveolar Lavage (BAL) is a more accurate diagnostic tool. Fiberoptic bronchoscopy is the most accurate technique for BAL but is expensive and requires a physician-led team. Non-bronchoscopic (NB)-BAL offers an alternative approach. METHODS: Previous practice at NMH for obtaining lower respiratory tract specimens was either bronchoscopy or ETA. NB-BAL has been increasingly used since its introduction in June 2005. Respiratory Care Practitioners (RRT, RCP) were trained to perform NB-BAL using the BALcath (Ballard Medical Products). Training is a three-step process from understanding the procedure to performing without assistance and minimum complications. The number of RCPs-trained increased until NB-BAL was routinely available at any time. As part of the training process, a robust evaluation of the following complications of NB-BAL was performed: hypoxemia, arrhythmias, hypo- or hypertension, bronchial hemorrhage, coughing, and pneumothorax. RESULTS: Between 12/2008 and 07/2009, 495 NB-BALs were performed, an almost 100% increase from previously. Despite the large increase in procedures and of different RCPs performing NB-BAL, the major complication rate remained < 5% (Figure). Minor complications averaged 10-15%, with most transient. CONCLUSIONS: Routine training of RCPs to perform NB-BAL increased availability and doubled the procedures performed. Rigorous training and tracking of complications allowed this increase in utilization and number of RCPs performing the procedure to occur without increased complications. Because of the safety and availability of NB-BAL, respiratory tract sampling by ETA is no longer offered at NMH. Sponsored Research - None ( the number in parentheses relate to the total number of NB-BAL procedures done each month)