Bronchoalveolar Lavages for Cytologic Assessment in Intensive Care Unit Patients

Completed

Brief Summary: 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: 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

Recruitment & Eligibility

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

Primary Outcome Measures

Name	Time	Method
contribution to diagnosis and/or therapeutic decision	72 hours	Investigators will be ask to answer the following question: Did the bronchoalveolar lavage results contribute to diagnosis and/or therapeutic decision: Yes or No
quality of performed bronchoalveolar lavage	72 hours	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).
frequency of use	72 hours	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

Secondary Outcome Measures

Name	Time	Method
Evolution of respiratory rate	24 hours	respiratory rate will be assessed before the bronchoalveolar lavage and 8 times during the 24 hours following the bronchoalveolar lavage
Evolution of oxygen needs	24 hours	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.
Need of tracheal intubation	24 hours	Percentage of patients not intubated while undergoing bronchoalveolar lavage that will need intubation within 24 hours

Locations (16): Hôpital RAYMOND POINCARE
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Garches, France
CH d'ANGOULEME
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Angoulême, France
CHU d'ANGERS
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Angers, France
CH Victor DUPOUY
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Argenteuil, France
CHD de VENDEE
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La Roche sur Yon, France
CHU de DIJON
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Dijon, France
CH de LA ROCHELLE
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La Rochelle, France
Hopital de La Timone
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Marseille, France
CH de MONTAUBAN
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Montauban, France
Hôpital Nord de Marseille
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Marseille, France
CHRU de NANTES
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Nantes, France
CHR d'ORLEANS
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Orléans, France
CHU de STRASBOURG
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Strasbourg, France
CHU de STRASBOURG NHC
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Strasbourg, France
CHRU de POITIERS
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Poitiers, France
CHRU de TOURS
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Tours, France