Safe and Efficient Practice of Bronchoscopic Sampling from Mechanically Ventilated Patients: A Structured Evaluation of the Ambu Bronchosampler-Ascope 4 Integrated System

Abstract

<b><i>Background:</i></b> Bronchoscopic sampling of bronchoalveolar fluid (BAL) should be safe and effective. Current sampling practice risks loss of sample to the attached negative flow, aerosolisation, or spillage, due to repeated circuit breaks, when replacing sample containers. Such concerns were highlighted during the recent coronavirus pandemic. <b><i>Objectives:</i></b> Evaluation of an alternative integrated sampling solution, with the Ambu Bronchosampler with aScope 4, by an experienced bronchoscopist in ICU. <b><i>Methods:</i></b> An observational study of 20 sequential bronchoscopic diagnostic sampling procedures was performed on mechanically ventilated patients with suspected ventilator-associated pneumonia. Mixed methods assessment was done. The predefined outcome measures were (1) ease of set up, (2) ease of specimen collection, (3) ease of protecting specimen from loss or spillage, and (4) overall workflow. The duration of the procedure and the % volume of sample retrieved were recorded. <b><i>Results:</i></b> The mean (±standard deviation [SD]) time for collecting 1 sample was 2.5 ± 0.8 min. The mean (±SD) specimen yield for instilled miniBAL was 54.2 ± 17.9%. Compared with standard sampling, the set-up was <i>much easier</i> in 18 (90%), or <i>easier</i> in 2 (10%) of procedures, reducing the connection steps. It was <i>much more</i> intuitive to use in 14 (70%), <i>more</i> intuitive in 4 (20%), and <i>no more</i> intuitive to use in 2 (10%). The overall set-up and workflow was <i>much easier</i> in 69% of the 13 intraprocedural connections and <i>easier</i> or <i>as easy</i> in the remaining 31% procedures. All procedures where pre connection was established were <i>much easier</i> (7, 100%). The Ambu Bronchosampler remained upright in all procedures with no loss or spillage of sample. Obtaining a sample was <i>much easier</i> in 60%, <i>easier</i> in 10%, <i>no different</i> in 20%, and <i>worse</i> in 10%. The ability to protect a sample from start to finish compared to standard procedures was <i>much easier</i> in 80%, <i>easier</i> in 15%, and <i>no different</i> in 5% of procedures. Overall workflow was <i>much easier</i> in 14 (70%), <i>easier</i> in 4 (20%), and <i>no different</i> in 2 (10%) of procedures. <b><i>Conclusions:</i></b> The Ambu Bronchosampler unit was a reliable, effective, and possibly safer technique for diagnostic sampling in ICU. It may improve safety standards during the coronavirus pandemic. A randomized control trial against the standard sampling technique is warranted.