Early bronchoalveolar lavage for intubated trauma patients with TBI or chest trauma.

Autor: Loftus TJ; Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Tyler.Loftus@surgery.ufl.edu., Lemon SJ; Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: lemosj@shands.ufl.edu., Nguyen LL; Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: linda.nguyen@ufl.edu., Voils SA; Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: svoils@cop.ufl.edu., Brakenridge SC; Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Scott.Brakenridge@surgery.ufl.edu., Jordan JR; Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Janeen.Jordan@surgery.ufl.edu., Croft CA; Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Chasen.Croft@surgery.ufl.edu., Smith RS; Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Steve.Smith@surgery.ufl.edu., Moore FA; Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Frederick.Moore@surgery.ufl.edu., Efron PA; Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Philip.Efron@surgery.ufl.edu., Mohr AM; Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Alicia.Mohr@surgery.ufl.edu.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2017 Jun; Vol. 39, pp. 78-82. Date of Electronic Publication: 2017 Feb 12.
DOI: 10.1016/j.jcrc.2017.02.010
Abstrakt: Purpose: To evaluate the efficacy of an early bronchoalveolar lavage (E-BAL) protocol. BAL was performed within 48 h for intubated patients with traumatic brain injury or chest trauma. We hypothesized that E-BAL would decrease antibiotic use and improve outcomes compared to late BAL (L-BAL) triggered by clinical signs of pneumonia.
Methods: Retrospective cohort analysis of 132 patients with quantitative BAL and ≥1 risk factor: head Abbreviated Injury Score ≥2, ≥3 rib fractures, or radiographic signs of aspiration or pulmonary contusion. E-BAL (n=71) was compared to L-BAL (n=61). Pneumonia was defined as ≥10 4 organisms on BAL or Clinical Pulmonary Infection Score >6.
Results: There were no significant differences in age, injury severity, initial Pao 2 :Fio 2 , or smoking status between E-BAL and L-BAL groups. 52% and 61% of the E-BAL and L-BAL cultures were positive, respectively. E-BAL patients had fewer antibiotic days (7.3 vs 9.2, P=.034), ventilator days (11 vs 15, P=.002), tracheostomies (49% vs 75%, P=.002), and shorter intensive care unit and hospital length of stay (13 vs 17 days (P=.007), 18 vs 22 days (P=.041)).
Conclusions: More than half of all E-BAL patients had pneumonia present early after admission. E-BAL was associated with fewer days on antibiotics and better outcomes than L-BAL.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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