» Articles » PMID: 39408080

Bronchoscopic Diagnosis of Severe Respiratory Infections

Overview
Journal J Clin Med
Specialty General Medicine
Date 2024 Oct 16
PMID 39408080
Authors
Affiliations
Soon will be listed here.
Abstract

The diagnosis of severe respiratory infections in intensive care remains an area of uncertainty and involves a complex balancing of risks and benefits. Due to the frequent colonisation of the lower respiratory tract in mechanically ventilated patients, there is an ever-present possibility of microbiological samples being contaminated by bystander organisms. This, coupled with the frequency of alveolar infiltrates arising from sterile insults, risks over-treatment and antimicrobial-associated harm. The use of bronchoscopic sampling to obtain protected lower respiratory samples has long been advocated to overcome this problem. The use of bronchoscopy further enables accurate cytological assessment of the alveolar space and direct inspection of the proximal airways for signs of fungal infection or alternative pathologies. With a growing range of molecular techniques, including those based on nucleic acid amplification and even alveolar visualisation and direct bacterial detection, the potential for bronchoscopy is increasing concomitantly. Despite this, there remain concerns regarding the safety of the technique and its benefits versus less invasive sampling techniques. These discussions are reflected in the lack of consensus among international guidelines on the topic. This review will consider the benefits and challenges of diagnostic bronchoscopy in the context of severe respiratory infection.

References
1.
Du Rand I, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S . British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax. 2013; 68 Suppl 1:i1-i44. DOI: 10.1136/thoraxjnl-2013-203618. View

2.
Schiller H, Montoro D, Simon L, Rawlins E, Meyer K, Strunz M . The Human Lung Cell Atlas: A High-Resolution Reference Map of the Human Lung in Health and Disease. Am J Respir Cell Mol Biol. 2019; 61(1):31-41. PMC: 6604220. DOI: 10.1165/rcmb.2018-0416TR. View

3.
Nandagopal L, Veeraputhiran M, Jain T, Soubani A, Schiffer C . Bronchoscopy can be done safely in patients with thrombocytopenia. Transfusion. 2015; 56(2):344-8. DOI: 10.1111/trf.13348. View

4.
Akram A, Chankeshwara S, Scholefield E, Aslam T, McDonald N, Megia-Fernandez A . In situ identification of Gram-negative bacteria in human lungs using a topical fluorescent peptide targeting lipid A. Sci Transl Med. 2018; 10(464). DOI: 10.1126/scitranslmed.aal0033. View

5.
Koehler P, Cornely O, Kochanek M . Bronchoscopy safety precautions for diagnosing COVID-19 associated pulmonary aspergillosis-A simulation study. Mycoses. 2020; 64(1):55-59. DOI: 10.1111/myc.13183. View