The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

NON-BRONCHOSCOPIC BRONCHIAL ALVEOLAR LAVAGE (NB-BAL)- A SAFE AND LESS EXPENSIVE PROCEDURE COMPARED TO BRONCHOSCOPIC BAL IN DIAGNOSING PNEUMONIAS IN THE ICUS.

Cherian Paily1, Richard Wunderink2, Sherif Afifi3, Robert Gould3, Craig Leonard1, Thomas Handler1, Nicole Willis1; 1Respiratory Care, Northwestern Memorial Hospital, Chicago, IL; 2Pulmonary Medicine, Northwestern Memorial Hospital, Chicago, IL; 3Anesthesiology, Northwestern Memorial Hospital, Chicago, IL

BACKGROUND: Critically ill patients who require mechanical ventilation (MV) are at risk of Ventilator Associated Pneumonia (VAP). Significant mortality and morbidity are attributed to VAP. While prevention of VAP is of great significance, optimal diagnosis for proper treatment without delay is critically important. Smear and culture results from upper airway secretions may give false positives which is estimated at 40 - 60%. Inaccurate culture results lead to inappropriate and unwanted antibiotic therapy and unnecessary cost. Non- Bronchoscopic Bronchoalveolar Lavage (NB-BAL) is a good diagnostic tool to identify pathogens in the lower respiratory tract, so appropriate treatment can be initiated. NB-BAL procedure consists of blind placement of a double lumen Catheter into the lung (Right or Left) in order to retrieve a bronchoalveolar lavage (BAL) fluid specimen. PROJECT: Northwestern Memorial Hospital is a level-one trauma center with 115 ICU beds. Ventilator days average 1200 per month. In the ICU's the current practice of obtaining a sputum specimen has either been via Fiberoptic Bronchoscopy (FB) or by Endotracheal Aspirate (ETA). FB is the most accurate and expensive of these techniques. Respiratory Care Practitioners were specially trained to perform NB-BAL using a BAL Catheter (Kimberly Clark). This procedure has gained widespread acceptance and popularity in our ICUs since its introduction in June 2005. RESULTS: 3907 NB-BAL specimens were collected from MV patients between June 2005 and April 2011. Major complications have been consistently low (0% - 5%) and minor complications have averaged < 15.0% ( see graph). Most adverse events have been transient; and resolved shortly after completion of the NB-BAL procedure. The most common adverse events were: hypoxemia, arrhythmias, hypotension, hypertension, bronchial hemorrhage and coughing during procedure. NB-BAL is less expensive and more readily available because a skilled physician is not required. It is also less invasive than FB while providing quick assessment of PNA and VAP in the ICU setting. Average cost for RCP-led NB-BAL at our institution is ~ $700.00 per procedure, compared to $5000.00 for Bronch BAL led by a Physician-led team. The total cost for 3907 NB-BAL Procedures over a five year period was = $2.70 Million. Total Cost for Bronch BAL would have been = $15.70 Million ($5000.00 x 3907), a noteable difference of ~$13.0 Million.
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