Early bronchoalveolar lavage for intubated trauma patients with TBI or chest trauma☆,☆☆,★

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Purpose:To evaluate the efficacy of an early bronchoalveolar lavage (E-BAL) protocol. BAL was performed within 48 h for intubated patients with traumatic brain injury or chest trauma. We hypothesized that E-BAL would decrease antibiotic use and improve outcomes compared to late BAL (L-BAL) triggered by clinical signs of pneumonia.Methods:Retrospective cohort analysis of 132 patients with quantitative BAL and ≥1 risk factor: head Abbreviated Injury Score ≥2, ≥3 rib fractures, or radiographic signs of aspiration or pulmonary contusion. E-BAL (n = 71) was compared to L-BAL (n = 61). Pneumonia was defined as ≥104 organisms on BAL or Clinical Pulmonary Infection Score >6.Results:There were no significant differences in age, injury severity, initial Pao2:Fio2, or smoking status between E-BAL and L-BAL groups. 52% and 61% of the E-BAL and L-BAL cultures were positive, respectively. E-BAL patients had fewer antibiotic days (7.3 vs 9.2, P = .034), ventilator days (11 vs 15, P = .002), tracheostomies (49% vs 75%, P = .002), and shorter intensive care unit and hospital length of stay (13 vs 17 days (P = .007), 18 vs 22 days (P = .041)).Conclusions:More than half of all E-BAL patients had pneumonia present early after admission. E-BAL was associated with fewer days on antibiotics and better outcomes than L-BAL.HighlightsEarly BAL (E-BAL) was performed within 48 h for high risk intubated trauma patientsE-BAL was compared to late BAL (L-BAL) triggered by signs of pneumonia52% of E-BAL cultures were positive, identifying pneumonia present on admissionE-BAL patients had fewer antibiotics days and better outcomes than L-BAL patients

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