Keisuke Anan1, Yoshiyasu Oshima2, Takayuki Ogura3, Yuko Tanabe4, Akiko Higashi5, Yoshiaki Iwashita6, Kensuke Fujita3, Takuo Yoshida7, Koichi Ando8, Satoshi Okamori9, Yohei Okada10. 1. Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan. Electronic address: ekusiek.nana@gmail.com. 2. Department of Pharmacy, Kobe Tokushukai Hospital, Kobe, Japan. 3. Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital, Tochigi, Japan. 4. Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan. 5. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. 6. Department of Emergency and Critical Care Medicine, Shimane University, Shimane, Japan. 7. Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan. 8. Division of Allergology and Respiratory Medicine, Department of Medicine, Showa University School of Medicine, Tokyo, Japan. 9. Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan. 10. Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Preventive Services, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Abstract
BACKGROUND: This review aimed to investigate whether bronchoalveolar lavage (BAL) is safe in patients with severe acute respiratory failure (ARF). METHODS: We searched the MEDLINE, CENTRAL, and other databases up to June 2, 2021 for studies that examined BAL for severe ARF. We included all cohort studies and randomized or non-randomized trials, while we excluded case-control studies, case reports, and case series. We evaluated the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: We included 17 studies (1085 patients) in the meta-analysis. The integrated frequency of death was 0.000% (95% confidence interval [CI]: 0.000-0.045%, I2 = 0.0%). The pooled risk of severe complications of respiratory system, cardiovascular system, and major bleeding was 1.32% (95% CI: 0.000-4.41%, I2 = 84.8%), 0.040% (95% CI: 0.000-0.71%, I2 = 9.3%), and 0.000% (95% CI: 0.000-0.27%, I2 = 0.0%), respectively. In the subgroup analysis with mechanical ventilation during BAL, there were few severe complications of the respiratory system (3/717 patients in 13 studies) and almost no heterogeneity (I2 = 0.0%). CONCLUSIONS: Our study suggests that severe complications of BAL for severe ARF are probably rare, particularly in patients receiving mechanical ventilation. After considering the risks and benefits, it would be worthwhile to consider performing BAL in patients with severe ARF of unknown etiology to pursue its cause. TRIAL REGISTRATION: The protocol was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000040600).
BACKGROUND: This review aimed to investigate whether bronchoalveolar lavage (BAL) is safe in patients with severe acute respiratory failure (ARF). METHODS: We searched the MEDLINE, CENTRAL, and other databases up to June 2, 2021 for studies that examined BAL for severe ARF. We included all cohort studies and randomized or non-randomized trials, while we excluded case-control studies, case reports, and case series. We evaluated the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: We included 17 studies (1085 patients) in the meta-analysis. The integrated frequency of death was 0.000% (95% confidence interval [CI]: 0.000-0.045%, I2 = 0.0%). The pooled risk of severe complications of respiratory system, cardiovascular system, and major bleeding was 1.32% (95% CI: 0.000-4.41%, I2 = 84.8%), 0.040% (95% CI: 0.000-0.71%, I2 = 9.3%), and 0.000% (95% CI: 0.000-0.27%, I2 = 0.0%), respectively. In the subgroup analysis with mechanical ventilation during BAL, there were few severe complications of the respiratory system (3/717 patients in 13 studies) and almost no heterogeneity (I2 = 0.0%). CONCLUSIONS: Our study suggests that severe complications of BAL for severe ARF are probably rare, particularly in patients receiving mechanical ventilation. After considering the risks and benefits, it would be worthwhile to consider performing BAL in patients with severe ARF of unknown etiology to pursue its cause. TRIAL REGISTRATION: The protocol was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000040600).
Authors: Lieuwe D J Bos; John G Laffey; Lorraine B Ware; Nanon F L Heijnen; Pratik Sinha; Brijesh Patel; Matthieu Jabaudon; Julie A Bastarache; Daniel F McAuley; Charlotte Summers; Carolyn S Calfee; Manu Shankar-Hari Journal: Intensive Care Med Exp Date: 2022-03-11