Bronchoalveolar Lavages for Cytologic Assessment in Intensive Care Unit Patients

Study Overview
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Brief Summary
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Little is known about bronchoalveolar lavages performed for cytological assessment during bronchial fibroscopy in critically ill patients. Frequency of use, indications, actual contribution to diagnosis and therapeutic decision, and complications have not been extensively assessed. The primary objective of this multi center, prospective, observational study is to describe the frequency of use of bronchoalveolar lavages for cytological assessement in critically ill patients, identify their indications, assess their contribution to diagnosis and therapeutic decisions, and estimate the frequency of induced respiratory events.

Detailed Description
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Secondary objectives will be to assess the frequency of poor quality bronchoalveolar lavages (as defined by either more than 5% bronchial epithelial cell count to less than 50,000 alveolar cells per mL) assess the contribution of a given bronchoalveolar lavage to the diagnostic work up assess the contribution of a given bronchoalveolar lavage results to therapeutic decision assess the induced short term respiratory side effects identify risk factors for poor respiratory tolerance

Official Title
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Bronchoalveolar Lavages in the Intensive Care Unit : Indications, Adverse Respiratory Effects, Contribution to Diagnosis and Therapy. A Multicenter, Prospective, Observational Study

Conditions
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Lung Diseases, Intensive Care

Intervention / Treatment
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* Procedure: bronchoalveolar lavage


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adult patient (> 18 yr-old) hospitalized in intensive care unit with acute and/or chronic lung disease that need bronchoalveolar lavage as part of routine diagnostic work up patient's or family consent Exclusion Criteria: consent not obtained patient already included at previous bronchoalveolar lavage of during previous hospitalization absence of social security number age < 18yr pregnant woman

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

| Intervention/Treatment |
| --- |
|Procedure: bronchoalveolar lavage|bronchoalveolar lavages performed for cytological assessment in critically ill patients with lung diseases, intubated or not|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| quality of performed bronchoalveolar lavage | pathologists examining bronchoalveolar lavage specimen will classify bronchoalveolar lavage as of poor quality or of good quality based upon cytologic assessment: bronchial cell count (not more than 5%) and alveolar cell count (above 50,000/mL). | 72 hours | 
| contribution to diagnosis and/or therapeutic decision | Investigators will be ask to answer the following question: Did the bronchoalveolar lavage results contribute to diagnosis and/or therapeutic decision: Yes or No | 72 hours | 
| frequency of use | the frequency of use of bronchoalveolar lavage will be describe and expressed as the proportion of patients who underwent bronchoalveoalr lavage upon the total number of patients admitted in the recruiting intensive care units during the study period | 72 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evolution of respiratory rate | respiratory rate will be assessed before the bronchoalveolar lavage and 8 times during the 24 hours following the bronchoalveolar lavage | 24 hours | 
| Evolution of oxygen needs | Oxygen needs, in L/min in patients under conventional nasal or facial oxygen therapy, or expressed in FiO2 in patients under nasal high flow oxygen or under invasive or noninvasive ventilation, will be recorded before bronchoalveolar lavage and 8 times during the following 24 hours. | 24 hours | 
| Need of tracheal intubation | Percentage of patients not intubated while undergoing bronchoalveolar lavage that will need intubation within 24 hours | 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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side effects, decision making, indications, risk factors