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VOLUME 25 , ISSUE 2 ( February, 2021 ) > List of Articles

Original Article

Use of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonitis

Mohammed M Megahed, Ahmed M El-Menshawy, Ahmed M Ibrahim

Citation Information : Megahed MM, El-Menshawy AM, Ibrahim AM. Use of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonitis. Indian J Crit Care Med 2021; 25 (2):146-152.

DOI: 10.5005/jp-journals-10071-23718

License: CC BY-NC 4.0

Published Online: 22-02-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background and objectives: Aspiration-induced lung injury accounts for a significant proportion of acute pulmonary dysfunction. Few studies were conducted to study the use of early bronchoscopy in mechanically ventilated patients with aspiration pneumonitis. This study aimed at assessing the clinical impact of early bronchoscopy for removal of gastric fluid and solid particles in the first 24 hours of mechanical ventilation (MV) on the progression of aspiration, MV days, intensive care unit (ICU) stay, development of pneumonia, and ICU mortality. Materials and methods: The study was an open-label randomized control trial and included 76 adult subjects mechanically ventilated due to aspiration pneumonitis, half the subjects received early bronchoscopy in the first 24 hours after aspiration for removal of aspirated material and bronchoalveolar lavage sampling, the other half received standard treatment. Results: The intervention group had a significant reduction in the rate of development of pneumonia at 60.5 vs 81.6%, p = 0.043 through the first week of admission, the intervention group has a significantly better hypoxic index (HI), white blood count, clinical pulmonary infection score, lung injury score, and sepsis-related organ failure assessment (SOFA) score compared to the control group. Although there was a reduction in mechanical ventilation days and ICU mortality in the intervention group vs control group that difference did not reach statistical significance. Conclusions: Early bronchoscopy in mechanically ventilated patients with aspiration pneumonitis can be beneficial in improving respiratory functions and decreasing the incidence of development of aspiration pneumonia and may guide the de-escalation of antibiotic therapy.

  1. Lee AS, Ryu JH. Aspiration pneumonia and related syndromes. Mayo Clin Proc 2018;93(6):752–762. DOI: 10.1016/j.mayocp.2018.03.011.
  2. Raghavendran K, Nemzek J, Napolitano LM, Knight PR. Aspiration-induced lung injury. Crit Care Med 2011;39(4):818–826. DOI: 10.1097/CCM.0b013e31820a856b.
  3. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001;344(9):665–671. DOI: 10.1056/NEJM200103013440908.
  4. Son YG, Shin J, Ryu HG. Pneumonitis and pneumonia after aspiration. J Dent Anesth Pain Med 2017;17(1):1–12. DOI: 10.17245/jdapm.2017.17.1.1.
  5. DiBardino DM, Wunderink RG. Aspiration pneumonia: a review of modern trends. J Crit Care 2015;30(1):40–48. DOI: 10.1016/j.jcrc.2014.07.011.
  6. Bonten MJ, Gaillard CA, van der Geest S, van Tiel FH, Beysens AJ, Smeets HG, et al. The role of intragastric acidity and stress ulcus prophylaxis on colonization and infection in mechanically ventilated ICU patients. A stratified, randomized, double-blind study of sucralfate versus antacids. Am J Respir Crit Care Med 1995;152(6 Pt 1):1825–1834. DOI: 10.1164/ajrccm.152.6.8520743.
  7. Spilker CA, Hinthorn DR, Pingleton SK. Intermittent enteral feeding in mechanically ventilated patients. The effect on gastric pH and gastric cultures. Chest 1996;110(1):243–248. DOI: 10.1378/chest.110.1.243.
  8. Rotta AT, Shiley KT, Davidson BA, Helinski JD, Russo TA, Knight PR. Gastric acid and particulate aspiration injury inhibits pulmonary bacterial clearance. Crit Care Med 2004;32(3):747–754. DOI: 10.1097/01.ccm.0000114577.10352.46.
  9. van Westerloo DJ, Knapp S, van't Veer C, Buurman WA, de Vos AF, Florquin S, et al. Aspiration pneumonitis primes the host for an exaggerated inflammatory response during pneumonia. Crit Care Med 2005;33(8):1770–1778. DOI: 10.1097/01.ccm.0000172277.41033.f0.
  10. Metheny NA, Clouse RE, Chang Y-H, Stewart BJ, Oliver DA, Kollef MH. Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors. Crit Care Med 2006;4(4):1007–1015. DOI: 10.1097/01.CCM.0000206106.65220.59.
  11. Moore FA. Treatment of aspiration in intensive care unit patients. JPEN J Parenter Enteral Nutr 2002;26(6 Suppl):S69–S74; discussion S74. DOI: 10.1177/014860710202600611.
  12. Rebuck JA, Rasmussen JR, Olsen KM. Clinical aspiration-related practice patterns in the intensive care unit: a physician survey. Crit Care Med 2001;(12):2239–2244. DOI: 10.1097/00003246-200112000-00001.
  13. Campinos L, Duval G, Couturier M, Brage D, Pham J, Gaudy JH. The value of early fibreoptic bronchoscopy after aspiration of gastric contents. Br J Anaesth 1983;55(11):1103–1105. DOI: 10.1093/bja/55.11.1103.
  14. Deng J-Q, Liu Z, Guo Z-H. [Early bronchoscopic sputum suction in elderly patients with aspiration pneumonia-induced acute heart and lung failure]. Nan Fang Yi Ke Da Xue Xue Bao 2009 29(6):1259–1260.
  15. Lee HW, Min J, Park J, Lee YJ, Kim SJ, Park JS, et al. Clinical impact of early bronchoscopy in mechanically ventilated patients with aspiration pneumonia. Respirology 2015;20(7):1115–1122. DOI: 10.1111/resp.12590.
  16. Kabadayi S, Bellamy MC. Bronchoscopy in critical care. BJA Educ 2017;17(2):48–56. DOI: 10.1093/bjaed/mkw040.
  17. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818–829.
  18. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22(7):707–710. DOI: 10.1007/BF01709751.
  19. Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 1988;138(3):720–723. DOI: 10.1164/ajrccm/138.3.720.
  20. Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 1991;143(5 Pt 1):1121–1129. DOI: 10.1164/ajrccm/143.5_Pt_1.1121.
  21. Hu X, Lee JS, Pianosi PT, Ryu JH. Aspiration-related pulmonary syndromes. Chest 2015;147(3):815–823. DOI: 10.1378/chest.14-1049.
  22. Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18(3):268–281. DOI: 10.1111/j.1469-0691.2011.03570.x.
  23. Kane-Gill SL, Olsen KM, Rebuck JA, Rea RS, Boatwright DW, Smythe MA, et al. Multicenter treatment and outcome evaluation of aspiration syndromes in critically ill patients. Ann Pharmacother 2007;41(4): 549–555. DOI: 10.1345/aph.1H675.
  24. Vejdan AK, Khosravi M. BAL for pneumonia prevention in tracheostomy patients: a clinical trial study. Pak J Med Sci 2013;29(1):148–151. DOI: 10.12669/pjms.291.1971.
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