Safety and tolerability of nonbronchoscopic lavage in ARDS

Study objective: This study compared the safety profiles of bronchoscopic lavage with nonbronchoscopic lavage in the investigation of patients with acute lung injury (ALI) or ARDS. Design: Single-center, randomized, cross-over study. Setting: General ICU in the United Kingdom. Participants: Fourteen patients with ALI or ARDS. Interventions: Bronchoscopic BAL and nonbronchoscopic BAL 1 h apart. Measurements and results: Hemodynamic and ventilatory parameters were recorded during and for 1 h following each procedure. On average, bronchoscopic lavage took longer to perform than nonbronchoscopic lavage (7 min and 6 s vs 2 min and 28 s, p < 0.001). During the procedures, bronchoscopic lavage increased heart rate and systolic BP more than nonbronchoscopic lavage (23% vs 10% [p < 0.01] and 18% vs 7% [p < 0.01]). Three patients had ST-segment depression during bronchoscopic, and one patient had ST-segment depression during nonbronchoscopic lavage (p = 0.298). Bronchoscopic lavage reduced minute ventilation by 63 ± 17.3%, while nonbronchoscopic lavage only reduced it by 36 ± 21.9% (p < 0.001). PaCO2 rose more after bronchoscopic lavage than after nonbronchoscopic lavage. Conclusion: Nonbronchoscopic lavage is associated with less marked physiologic derangements than bronchoscopic lavage. Further studies are required to validate the hypothesis that nonbronchoscopic lavage may be safer in patients with unstable coronary heart disease or head injury/raised intracranial pressure who are at risk from unpredictable fluctuations in hemodynamic and ventilatory profiles