The Value of Early Fibreoptic Bronchoscopy After Aspiration of Gastric Contents

Abstract

Fibreoptic bronchoscopy was undertaken in 26 patients upon hospital admission, to assess if they were suffering from pulmonary lesions subsequent to the aspiration of gastric contents. In 24 of these patients erythematous lesions were observed (sensitivity of the procedure: 92.3%), mainly on the carina. Distal to the carina, the lesions were observed less frequently. The procedure caused no complications in any of the patients studied.

Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit

“…Of the eight EOP-NR patients with vomiting and impaired vigilance, three died in hospital, two improved later without change of antibiotic drugs, whereas in the remaining three change to the following antibiotic medications was effective: fluconazole (n = 2), imipenem (n = 1), vancomycine (n = 1). Two of these eight EOP-NR patients fulfilled clinical and bronchoscopic criteria of pneumonitis due to gastric acid aspiration [16,18].…”

Fiberoptic bronchoscopy in brain-dead organ donors.

“…In critically ill patients, the use of bronchoscopy has greatly increased, with both diagnostic and therapeutic goals, such as diagnosis of aspiration pneumonitis, hemoptysis, and traumatic tracheobronchial lesions, management of atelectasis, and bacteriologic diagnosis of nosocomial pneumonia (11,12,17). Although its role following cardiopulmonary transplantation has also been recognized (18), fiberoptic bronchoscopy has not yet been evaluated in brain-dead organ donors.…”

“…However, the number of lung donors in our study is too small to draw any strong conclusion and only a large multicenter prospective study could determine the consequence of each main fiberoptic bronchoscopic diagnosis on the recipient outcome. Some investigators have suggested that serial chest X-ray and arterial blood gas analyses should be performed to detect contraindication for lung harvesting (12). This recommendation is probably of some value, but we do not consider that it could replace bronchoscopy; alterations in serial chest X-rayand/or arterial blood gas analysis could not occur because of the short time lapse between the diagnosis of brain death and organ harvesting as early as possible, and undue preparation of the potential recipient and transplantation team is time and energy consuming, and associated with emotional problems.…”

“…The following diagnosis could be made: (1) normal bronchoscopy; (2) inhalation of blood; (3) inhalation of gastric contents; (4) pulmonary contusion; (5) purulent bronchial secretions. The diagnosis of inhalation of blood was made when blood was observed below the endotracheal tube with clots, whereas the diagnosis of inhalation of gastric contents was made when liquid and/or foreign bodies similar to alimentary debris were observed (12).These two diagnoses could be performed simultaneously. Diagnosis of pulmonary contusion was made when distal hemorrhage without clotting was observed (11).…”

“…The criteria used for selecting lung donors included normal chest X-ray and adequate gas exchange (4)(5)(6)(7)(8)(9)(10), but a normal bronchoscopic examination has been required by only a few teams (8)(9)(10). Fiberoptic bronchoscopy has never been assessed in organ donors, although it has been recognized as a valuable diagnostic tool in chest trauma (11) and aspiration pneumonitis (12). We thus conducted a prospective study of fiberoptic bronchoscopy in brain-dead donors.…”