Abstract Background Diagnostic sampling for bronchial washes is inefficient and potentially unsafe. There is risk of aerosolization, poor yields or loss of sample to wall suction. Further, set-up and connectivity of sampling containers is often challenging. Research Question: Can Closed system sampling, such as the Ambu Bronchosampler (ABS), produce safer, more efficient diagnostic sampling than standard containers. We tested this premise in critically ill patients. Methods A multicenter, open label randomized controlled trial, saw 188 bronchoscopies performed in mechanically ventilated patients requiring diagnostic sampling or therapy. The closed system ABS was compared to standard sampling containers (SSC) connected to a single use bronchoscope (Ambu A4TM) for the primary outcomes of safety (spill or unplanned disconnection) and sampling efficiency (individually; ease of connectivity, setup, loss of sample, % volume retrieved). Secondary efficiency outcomes and tertiary outcomes of bronchoscopy process were also measured. Results The ABS group had significantly better safety than SSC; spills 0% v 23.7% 0/94 v 22/93, p 0.001; Unplanned tube disconnections 5.3% v 21.3%, 5/95 v 20/93, p 0.001; Unplanned container disconnections 2.1% v 7.5% 2/95 v 7/93, p = 0.08. Efficiency was significantly higher in ABS than SSC (acceptable/very or easy) Set up 100% v 68.9% 94/94 v 60/87 , Connectivity 100% v 12.8% 88/88 v 11/86, Keep upright 96.8% v 10.8% 92/95 v 10/93, and Loss of sample 11.6% v 48.4% 11/95 v 45/93, all p 0.001. Volume retrieved% was the same for both groups (33.0% 22-60 v 35.4% 11,59, p 0.2). The improved safety and efficiency of ABS held when adjusted for bronchoscopy experience, and per frequent bronchoscopist. Bronchoscopy was safe, mainly preceded by checklists, and imaging. Interpretation Closed system bronchoscopic sampling was safer (less spill or unplanned disconnections) and more efficient (set up, connectivity, and loss prevention) than standard containers for bronchoscopy sampling. Closed system diagnostic sampling devices should be the standard of care during bronchoscopy. Clinicaltrials.gov NCT05964075 Keywords: Bronchoscopy, Bronchial sampling, Bronchial lavage, closed system sampling, single use flexible bronchoscopy, Ambu bronchosampler, critical illness, mechanical ventilation, aerosolization, safety, efficiency This abstract is funded by: Ambu A/S Ltd
Singh et al. (Fri,) studied this question.