Rapid Detection of Airway Pathogens in Lung Transplant Donors
J. ChenJohn R. GreenlandB. TrinhSteven R. HaysJeffrey A. GoldenAida VenadoJonathan HooverFred DeiterJonathan P. SingerMarek BrzezińskiJasleen Kukreja
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Multiplex
Objective To assess whether distal bronchoalveolar lavage(DBAL) with plastic tubing allowed recovery of more fluid in comparison with common bronchoalveolar lavage(CBAL), and whether tubing had a favorable impact on operative procedure and complications. Methods A randomized study was performed in the hospital. Patients scheduled for BAL were randomly assigned to DBAL (n = 66) and CBAL (n = 56) group. Results In DBAL group,5.55% more fluid was recovered,9. 19% fewer technical failures,and 7.41% fewer complications were recorded. Conclusions Based on these results, we recommend performing DBAL using plastic tubing to replace CBAL.
Key words:
Bronchoalveolar lavage; Methods; Distal bronchoalveolar lavage; Common bronchoalveolar lavage
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We developed an ex vivo lung CT (EVL-CT) technique that allows us to obtain detailed CT images and morphologically assess the retrieved lung from a donor for transplantation. After we recovered the lung graft from a brain-dead donor, we transported it to our hospital and CT images were obtained ex vivo before lung transplant surgery. The objective of this study was to investigate the correlation between the EVL-CT findings and post-transplant outcome in patients who underwent bilateral lung transplantation (BLT) or single lung transplantation (SLT).We retrospectively reviewed the records of 70 patients with available EVL-CT data who underwent BLT (34 cases) or SLT (36 cases) in our hospital between October 2007 and September 2017. The recipients were divided into 2 groups (control group, infiltration group) according to the findings of EVL-CT of the lung graft in BLT and SLT, respectively. Recipients in the control group were transplanted lung grafts without any infiltrates (BLT control group, SLT control group). Recipients in the infiltration group received lung grafts with infiltrates (BLT infiltration group, SLT infiltration group).The recipients in the BLT infiltration group showed significantly slower recovery from primary graft dysfunction and a longer mechanical ventilation period and ICU stay period than those in the BLT control group. The mechanical ventilation period was significantly longer in the recipients in the SLT infiltration group than those in the SLT control group.EVL-CT may predict the outcome of the early phase after lung transplantation.
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Bronchoalveolar lavage (BAL) is a well-established diagnostic tool for the assessment of pulmonary diseases in adults. How BAL contributes to the diagnostic process in childhood lung diseases is less clear. One of the problems in interpreting BAL findings in children is that there are few reference data for BAL fluid constituents in children. This report addresses some of the technical problems of bronchoalveolar lavage in children and summarizes current knowledge on cellular and noncellular bronchoalveolar lavage fluid components in children without lung disease.
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Purpese: Lung transplantation is now accepted as an effective therapy for end-stage pulmonary vascular and parenchymal diseases. Rejection is a major impediment to long-term survival of lung transplant recipients. Lung allograft rejection has been studied in various animal models. To study the immunological mechanism of its rejection the studies on lung allograft rejection must be performed in inbred animals such as mice or rats, However, it is very delicate and difficult to transplant the lung in small inbred animals, especially in mice. The technical difficulty hampered the investigations of lung allograft rejection. Methods: This study introduced the new lung transplantation technique in mice for immunological study, subcutaneous lung tissue transplantation, in which the piece of lung tissue with 1-1.5 mm thickness was introduced subcutaneously through incision site on flank and transplanted to subcutaneous site of shoulder of mouse. Histological changes were followed up in transplanted lung tissues for 18 to 21 days. Lung tissues from CBA mice or Balb/c mice were subcutaneously transplanted to Balb/c mice in experimental or control group respectively. Results: Histological changes in the grafts of experimental groups could be divided into 4 phases, inflammatory, immunological, necrotic and fibrotic phase, Immunological or necrotic phase in this study correlated with grade 1-3 or grade 3-4 of acute lung rejection classified by the Lung Rejection Study Group. Conclusion: It is concluded that the subcutaneous lung tissue transplantation can be a technique for immunological study on acute lung allograft rejection in mice.
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Objectives: To evaluate the yield of mini-bronchoalveolar lavage compared with that of directed bronchoalveolar lavage in critically ill patients with suspected coronavirus disease 2019–associated pulmonary aspergillosis. Design: A retrospective cohort study. Setting: The ICU of the Amsterdam University Medical Centers. Patients: Patients with confirmed coronavirus disease 2019 screened for coronavirus disease 2019–associated pulmonary aspergillosis. INTERVENTIONS: Mini-bronchoalveolar lavage and/or directed bronchoalveolar lavage. Measurements and Main Results: In total, 76 patients were included, 20 of whom underwent bronchoalveolar lavage, 40 mini-bronchoalveolar lavage, and 16 both mini-bronchoalveolar lavage and bronchoalveolar lavage. The percentage of samples with one or more positive Aspergillus detecting test (galactomannan, culture, polymerase chain reaction) did not differ significantly between bronchoalveolar lavage and mini-bronchoalveolar lavage (16.7% vs 21.4%). However, in mini-bronchoalveolar lavage samples, this was more frequently driven by a positive polymerase chain reaction than in bronchoalveolar lavage samples (17.9% vs 2.8%; p = 0.030). In 81% of patients (13/16) with both mini-bronchoalveolar lavage and bronchoalveolar lavage, the test results were in agreement. In 11 of 12 patients (92%) with first a negative mini-bronchoalveolar lavage, the subsequent bronchoalveolar lavage sample was also negative. Conclusions: We found a similar percentage of positive test results in mini-bronchoalveolar lavage and bronchoalveolar lavage samples in patients with suspected coronavirus disease 2019–associated pulmonary aspergillosis. Our findings indicate that mini-bronchoalveolar lavage could be a useful tool for coronavirus disease 2019–associated pulmonary aspergillosis screening in ICU patients.
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The value of a new technique of protected bronchoalveolar lavage not requiring bronchoscopy was prospectively evaluated for the diagnosis of nosocomial pneumonia in two groups of critically ill patients. The control group was comprised of 29 patients free of any pulmonary disease whose lungs were ventilated for a mean time of 14 +/- 9 days (mean +/- SD). The pneumonia group was comprised of 30 patients with histologically proven nosocomial pneumonia whose lungs were ventilated for a mean time of 11 +/- 8 days. All patients of the pneumonia group died, and postmortem lung biopsies were taken for bacteriologic and pathologic examination. Twice a week in the control group or within the day preceding death in the pneumonia group, distal bronchial samples were obtained by a technique of protected bronchoalveolar lavage performed at the bedside. Fifty-one distal bronchial samples were bacteriologically analyzed in the control group and 30 in the pneumonia group. The sensitivity of a positive protected bronchoalveolar lavage for diagnosing nosocomial pneumonia was 80%, whereas the specificity was 66%. In 73% of the patients of the pneumonia group, the microorganisms isolated in the protected bronchoalveolar lavage and in the lung culture were partially (16%) or completely in agreement (57%). Among the 43 microorganisms isolated in the lung cultures, 74% were recovered by the protected bronchoalveolar lavage technique. This study shows that the protected bronchoalveolar lavage is an accurate technique for the diagnosis of nosocomial pneumonia. Because the technique is simple, noninvasive, easily repeatable at the bedside, and enables gram staining, it represents an attractive alternative to the fiberoptic bronchoscopy technique using a plugged double-sheathed brush.
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