A case series of bronchoscopy and bronchoalveolar lavage in critically ill patients with pneumonia and respiratory failure

Authors

  • Edi Darmawan
    Department of Anesthesiology and Intensive Care, dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia
  • Rizki Taufiqurrahman
    Department of Anesthesiology and Intensive Care, dr. H. Yuliddin Away General Hospital, South Aceh, Indonesia
  • Sutan Syarif Muda Dalimunthe
    Department of Anesthesiology and Intensive Care, H. OK Arya Zulkarnaen Regional General Hospital, Batubara, Indonesia
  • Septian Adi Permana
    Department of Anesthesiology and Intensive Care, dr. Moewardi General Hospital, Surakarta, Indonesia
  • Arie Zainul Fatoni
    Department of Anesthesiology and Intensive Care, dr. Saiful Anwar General Hospital, Malang, Indonesia
  • Teuku Yasir
    Department of Anesthesiology and Intensive Care, dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia
  • Andriamuri Primaputra Lubis
    Department of Anesthesiology and Intensive Care, H. Adam Malik General Hospital, Medan, Indonesia
  • Rommy Fransiscus Nadeak
    Department of Anesthesiology and Intensive Care, H. Adam Malik General Hospital, Medan, Indonesia
  • Bastian Lubis
    Department of Anesthesiology & Intensive Care, Faculty of Medicine, Universitas Sumatera Utara

Abstract

Introduction: Flexible bronchoscopy with bronchoalveolar lavage (BAL) is used in the ICU for sampling the lower respiratory tract and clearing secretions. We describe our experience with bronchoscopy for diagnosis and treatment in critically ill patients with pneumonia and respiratory failure.


Methods: This retrospective case series involved 18 critically ill adults with pneumonia and respiratory failure undergoing bronchoscopy with BAL in the ICU. BAL culture results, blood inflammatory markers (total leukocyte count, neutrophil and lymphocyte percentages, and neutrophil-to-lymphocyte ratio [NLR]), arterial blood gas values, and radiographic changes were recorded before and after the procedure. No hypothesis testing was conducted.


Results: BALF culture was positive in all patients, yielding 22 isolates. Gram-negative bacilli predominated (19/22 isolates; 86.4%), with Acinetobacter baumannii most frequent (9 patients; 50%), followed by Klebsiella pneumoniae and Pseudomonas aeruginosa; four patients (22.2%) had polymicrobial growth. Postoperatively, median leukocyte count was lower than baseline (21.69 vs 13.24 ×10³/µL; lower in 15 patients), and median NLR decreased (10.97 vs 5.85; lower in 14 patients), with increased lymphocyte percentage. Radiographic infiltrates regressed in 13 patients (72.2%); pH, PaCO₂, and arterial oxygen saturation were stable.


Conclusion: This case series shows bedside bronchoscopy with BAL provided high microbiological yield of multidrug-resistant Gram-negative organisms, with improvement in inflammatory markers and radiographic infiltrates. As all patients received antimicrobial therapy and supportive care, changes cannot be solely attributed to bronchoscopy; nonetheless, it illustrates bronchoscopy's diagnostic and therapeutic role in the ICU.

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