Treatment Change and Prognosis Effect of Fiberoptic Bronchoscopic Sampling in the Intensive Care Unit

Objective:Bronchoscopy is important for the diagnosis and treatment planning of patients in the intensive care unit, especially for infectious conditions. However, increasing evidence is reported in recent guidelines showing that bronchoscopic sampling is not superior compared with endotracheal aspirate (ETA). This study aimed to evaluate the contribution of bronchoscopic sampling to antibiotic treatment and its effect on intensive care mortality.Materials and Methods:This retrospective observational study evaluated the data of 75 patients who were followed up under invasive mechanical ventilation using the intensive care fiberoptic bronchoscopy (FB) database.Results:The mean age of patients was 66.0±15.4 years, and 28 (37.32%) were female and 47 (62.7%) were male. The mean acute physiology and chronic health evaluation-II score was 23.1±6.2. Median FB timing was 7.0 (2.0-15.0) days after the intensive care unit admission. Indications for FB were infection evaluation in 44 patients, airway evaluation in 26 patients, hemoptysis-alveolar hemorrhage in 3 patients, and interstitial lung disease suspicion in 2 patients. Active immune suppression was present in 24 (32%) patients. Evaluation of ETA results revealed bacterial and fungal growth in 31 patients (41.3%). After FB sampling, 41 patients (54.6%) were found to have bacterial and fungal growth, and treatment was changed in 16 (21.3%) patients with FB sampling. However, no significant relationship was found between the change of treatment after FB and mortality in the intensive care unit (p=0.250).Conclusion:Our study has two important results. First, ETA and FB sampling results were found to be similar. Second, no correlation was found between treatment change after FB in the late period and mortality in intensive care. The application of FB, which is an invasive procedure, could be the right approach in selected patients.