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. 2023 May;20(5):621-631.
doi: 10.1513/AnnalsATS.202302-106ST.

Research Bronchoscopies in Critically Ill Research Participants: An Official American Thoracic Society Workshop Report

Carmen Mikacenic, Lynn A Fussner, Jasmine Bell, Ellen L Burnham, Linda L Chlan, Sarah K Cook, Robert P Dickson, Francis Almonor, Fengming Luo, Karan Madan, Luisa Morales-Nebreda, Kara J Mould, A John Simpson, Benjamin D Singer, Renee D Stapleton, Chris H Wendt, D Clark Files

Research Bronchoscopies in Critically Ill Research Participants: An Official American Thoracic Society Workshop Report

Carmen Mikacenic et al. Ann Am Thorac Soc. 2023 May.

Abstract

Bronchoscopy for research purposes is a valuable tool to understand lung-specific biology in human participants. Despite published reports and active research protocols using this procedure in critically ill patients, no recent document encapsulates the important safety considerations and downstream applications of this procedure in this setting. The objectives were to identify safe practices for patient selection and protection of hospital staff, provide recommendations for sample procurement to standardize studies, and give guidance on sample preparation for novel research technologies. Seventeen international experts in the management of critically ill patients, bronchoscopy in clinical and research settings, and experience in patient-oriented clinical or translational research convened for a workshop. Review of relevant literature, expert presentations, and discussion generated the findings presented herein. The committee concludes that research bronchoscopy with bronchoalveolar lavage in critically ill patients on mechanical ventilation is valuable and safe in appropriately selected patients. This report includes recommendations on standardization of this procedure and prioritizes the reporting of sample management to produce more reproducible results between laboratories. This document serves as a resource to the community of researchers who endeavor to include bronchoscopy as part of their research protocols and highlights key considerations for the inclusion and safety of research participants.

Keywords: acute respiratory distress syndrome; bronchoscopy; critical illness; respiratory failure; ventilator-associated pneumonia.

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Figures

Figure 1.
Figure 1.
Research bronchoscopy with bronchoalveolar lavage protocol outline. This can be modified to meet study-specific needs and institutional review board requirements. Small endotracheal tube is defined as <2 mm between the inner diameter of endotracheal tube and outer diameter of bronchoscope. BAL = bronchoalveolar lavage; BP = blood pressure; HR = heart rate; ICP = intracranial pressure; LAR = legally authorized representative; MAP = mean arterial pressure; O2 sat = oxygen saturation; PA = pulmonary artery; PaO2/FiO2 = partial pressure of oxygen in the arterial blood to fraction of inspired oxygen; WBC = white blood cells.
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