This article is part of Pulmonology Advisor‘s coverage of the American Thoracic Society International Conference, taking place in Dallas, Texas. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from ATS 2019.
DALLAS — Performing therapeutic bronchoscopy at the time of intensive care unit (ICU) admission may decrease ventilator-associated pneumonia incidence in patients with level I trauma, according to research presented at the American Thoracic Society International Conference, held May 17-22, in Dallas, Texas.
Researchers performed a retrospective review of patients who were admitted to their facility’s neurologic trauma ICU at Parkview Medical Center in Pueblo, Colorado, between 2010 and 2017. Based on timing of bronchoscopic evaluation, patients were divided into 2 groups: those admitted before 2014 and those admitted after 2014. The researchers wanted to perform therapeutic bronchoscopy as a preventive measure in all patients with level I trauma within 48 hours of admission to the ICU. The number of days spent on mechanical ventilation, length of stay in the ICU, and incidence of pneumonia in both cohorts were reviewed.
A total of 58 patients with level I trauma who were intubated underwent therapeutic bronchoscopy before 2014, on average 5.7 days from ventilator initiation. After 2014 and therapeutic bronchoscopy implantation, 90 patients with level I trauma who were intubated underwent bronchoscopy, on average 2.9 days from ventilator initiation. Demographics were similar between the groups.
Pneumonia developed in 31% of patients intubated before 2014 compared with 8% of patients postimplantation of therapeutic bronchoscopy (P <.001). The researchers found no significant differences in the number of days spent on mechanical ventilation, length of stay in the ICU, or length of stay in the hospital.
“Our protocol was safe with no observed clinical complications secondary to bronchoscopy,” the researchers wrote. “We propose further studies be conducted to evaluate the role of therapeutic bronchoscopy in this patient population, including a multicenter randomized controlled trial to evaluate if therapeutic bronchoscopy should be a standardized protocol [in] all intubated level I trauma patients.”
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Wydro L, Gordon J, Patel A, et al. Early therapeutic bronchoscopy in mechanically ventilated level I trauma patients to prevent pneumonia at a community based hospital. Presented at: the American Thoracic Society International Conference; May 22, 2019; Dallas, TX. Abstract A6486/P689.