CLE and OCT in Acute Respiratory Insufficiency

Study Overview
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Brief Summary
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Acute respiratory distress syndrome is a severe complication of critical illness. The diagnosis of ARDS is difficult, and it could be important to differentiate ARDS from other causes of acute respiratory failure. Innovative probe-based imaging techniques such as 'Confocal Laser Endomicroscopy' (CLE) and Optical Coherence Tomography (OCT) are high resolution optical techniques that, combined with conventional bronchoscopy, have been found to provide non-invasive, real-time near-histology information about the alveolar compartment in non ventilated non-critically ill patients.

Detailed Description
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It is important to identify the underlying cause of respiratory failure, in order to determine the appropriate treatment. Histopathology would help treatment decisions, however is in the fast majority of this critically ill patient-group not available. CLE is enables near histology/microscopic analysis during bronchoscopy, by tissue illumination with a low-power laser. Optical Coherence Tomography is the optical equivalent of B-mode ultrasonography, that consists of a small rotating optical fibre. Both the CLE and OCT techniques are minimally invasive and little time consuming. Therefore different areas of the lung can be sequentially imaged. With this pilot study the investigators aim to describe normal alveolar areas and areas with abnormalities in critically ill patients with non resolving acute respiratory failure mandating a standard bronchoscopy or laryngoscopy with or without bronchoalveolar lavage.

Official Title
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Confocal Laser Endomicroscopy and Optical Coherence Tomography in Acute Respiratory Insufficiency

Conditions
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Acute Respiratory Failure (Non Resolving)

Intervention / Treatment
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* Device: Probe based optical techniques


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Admitted to intensive care unit of academic medical center in Amsterdam Indication for a procedure to investigate the airways that can be combined with pCLE/OCT Exclusion Criteria: Inability and willingness to provide informed consent by family-members Inability to comply with the study protocol

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Mechanically ventilated patients<br>Critically ill patients of 18 years or older who receive invasive mechanical ventilation for acute respiratory failure and have an indication for an intervention in the airways. | Device: Probe based optical techniques<br>* During the intervention of inspecting the airways, different segments of the alveolar compartment will be imaged by two different probe based (CLE and OCT).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Technical feasibility of various (diseased/non-diseased on HRCT-scan) alveolar compartments in mechanically ventilated patients | Percentage of successful imaging | coss sectional (1 day) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison of pCLE/OCT to radiological patterns | Degree of similarity pCLE/OCT-imaging compared to HRCT | cross sectional (1 day) | 
| Comparison of pCLE/OCT with pathology | Degree of similarity between pCLE/OCT characteristics with pathology (in case available) | cross sectional (1 day) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Confocal Laser Endomicroscopy, Optical coherence Tomography