• Tyler J Loftus, Stephen J Lemon, Linda L Nguyen, Stacy A Voils, Scott C Brakenridge, Janeen R Jordan, Chasen A Croft, R Stephen Smith, Frederick A Moore, Philip A Efron, and Alicia M Mohr.
• Department of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL 32610. Electronic address: Tyler.Loftus@surgery.ufl.edu.
• J Crit Care. 2017 Jun 1; 39: 78-82.

PurposeTo 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.MethodsRetrospective 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.ResultsThere 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)).ConclusionsMore 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.Copyright © 2017 Elsevier Inc. All rights reserved.

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