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

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.

Early bronchoscopy in severe pneumonia patients in intensive care unit: insights from the Medical Information Mart for Intensive Care-IV database analysis

“…A systematic review, however, found no statistically significant association between bronchoscopy and the transmission of acute respiratory infections [ 23 ]. Furthermore, the requirement of sedation may pose challenges in some patient groups [ 24 ]. It is therefore essential to adopt a cautious approach while using bronchoscopy because of its inherent limitations, to ensure that the possible advantages are carefully evaluated in relation to the associated hazards.…”

Research Bronchoscopy Standards and the Need for Noninvasive Sampling of the Failing Lungs

“…We read, with great interest, “Research Bronchoscopies in Critically Ill Research Participants: An Official American Thoracic Society Workshop Report” ( 1 ), which outlined research practice standards for bronchoscopy that serve as the reference methodology for sampling of the lower respiratory tract (LRT). We echo the Workshop Report conclusions that research bronchoscopy in the intensive care unit is valuable, safe, and feasible.…”

Reply: Research Bronchoscopy Standards and the Need for Noninvasive Sampling of the Failing Lungs

“…We appreciate the comments from Dr. Bain and colleagues regarding our recent American Thoracic Society Workshop Report titled “Research Bronchoscopies in Critically Ill Research Participants” ( 1 ). They highlighted the main goals of our proposal, which were to provide considerations regarding procedural standardization of bronchoscopy with bronchoalveolar lavage (BAL) and to summarize the existing evidence that this procedure is valuable, safe, and feasible in critical illness.…”