Safe and efficient practice of bronchoscopic sampling from mechanically ventilated patients: a structured evaluation of the ambu bronchosampler-ascope 4 integrated system
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Published version
Author(s)
Singh, Suveer
Shah, Pallav L
Type
Journal Article
Abstract
BACKGROUND: Bronchoscopic sampling of bronchoalveolar fluid (BAL) should be safe and effective. Current sampling practice risks loss of sample to the attached negative flow, aerosolisation, or spillage, due to repeated circuit breaks, when replacing sample containers. Such concerns were highlighted during the recent coronavirus pandemic. OBJECTIVES: Evaluation of an alternative integrated sampling solution, with the Ambu Bronchosampler with aScope 4, by an experienced bronchoscopist in ICU. METHODS: An observational study of 20 sequential bronchoscopic diagnostic sampling procedures was performed on mechanically ventilated patients with suspected ventilator-associated pneumonia. Mixed methods assessment was done. The predefined outcome measures were (1) ease of set up, (2) ease of specimen collection, (3) ease of protecting specimen from loss or spillage, and (4) overall workflow. The duration of the procedure and the % volume of sample retrieved were recorded. RESULTS: The mean (±standard deviation [SD]) time for collecting 1 sample was 2.5 ± 0.8 min. The mean (±SD) specimen yield for instilled miniBAL was 54.2 ± 17.9%. Compared with standard sampling, the set-up was much easier in 18 (90%), or easier in 2 (10%) of procedures, reducing the connection steps. It was much more intuitive to use in 14 (70%), more intuitive in 4 (20%), and no more intuitive to use in 2 (10%). The overall set-up and workflow was much easier in 69% of the 13 intraprocedural connections and easier or as easy in the remaining 31% procedures. All procedures where pre connection was established were much easier (7, 100%). The Ambu Bronchosampler remained upright in all procedures with no loss or spillage of sample. Obtaining a sample was much easier in 60%, easier in 10%, no different in 20%, and worse in 10%. The ability to protect a sample from start to finish compared to standard procedures was much easier in 80%, easier in 15%, and no different in 5% of procedures. Overall workflow was much easier in 14 (70%), easier in 4 (20%), and no different in 2 (10%) of procedures. CONCLUSIONS: The Ambu Bronchosampler unit was a reliable, effective, and possibly safer technique for diagnostic sampling in ICU. It may improve safety standards during the coronavirus pandemic. A randomized control trial against the standard sampling technique is warranted.
Date Issued
2021-01-07
Date Acceptance
2020-09-24
Citation
Respiration: international journal of thoracic medicine, 2021, 100 (1), pp.27-33
ISSN
0025-7931
Publisher
Karger Publishers
Start Page
27
End Page
33
Journal / Book Title
Respiration: international journal of thoracic medicine
Volume
100
Issue
1
Copyright Statement
© 2021 The Author(s)Published by S. Karger AG, Basel. This is an Open Access article licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense), applicable to the online version of the article only. Usage and distribution for com-mercial purposes requires written permission.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33412544
PII: 000511982
Subjects
Aerosolisation
Bronchoalveolar fluid
Bronchoscopic sampling
Bronchoscopy
COVID-19
Disposable bronchoscopy
Efficacy
Infection control
Intensive care unit
Safety
Publication Status
Published
Coverage Spatial
Switzerland
Date Publish Online
2021-01-07