ArticleBMJ open quality2026
Non-directed bronchoalveolar lavage: improving the quality and timing of pneumonia diagnosis in mechanically ventilated patients in the intensive care unit.
Article in BMJ open quality, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEarly respiratory sampling in mechanically ventilated patients with suspected community-acquired pneumonia (CAP) is essential for guiding antimicrobial therapy, but endotracheal aspirate (ETA) is frequently contaminated with upper airway flora and bronchoscopic bronchoalveolar lavage (BAL) is invasive. Non-directed BAL (ND-BAL) can be performed at the bedside without bronchoscopy and has comparable diagnostic accuracy to bronchoscopic BAL.
aimTo implement ND-BAL as a bedside procedure for mechanically ventilated intensive care unit (ICU) patients admitted within 48 hours of hospital admission with suspected CAP, increasing the proportion receiving a respiratory sample within 6 hours of ICU admission from 38% to ≥70% over 12 months and to compare oral flora contamination between ETA and ND-BAL.
methodsA multidisciplinary team introduced a standardised ND-BAL protocol in a tertiary ICU. Baseline audit (January-December 2023) was compared with postimplementation data (March 2024-February 2025).
resultsThe proportion of eligible patients with a respiratory sample collected within 6 hours increased from 14/40 (35%) to 34/44 (77%). ND-BAL samples demonstrated lower oral flora contamination than ETA (50% vs 90.9%). Legionella culture testing increased from 15% to 56.8%, while empiric methicillin-resistant Staphylococcus aureus and Legionella antimicrobial coverage remained similar. No ND-BAL-related adverse events were identified.
conclusionND-BAL was feasibly integrated as a joint nursing-medical bedside procedure and improved the timeliness and quality of respiratory sampling in mechanically ventilated patients with suspected CAP. This provides a platform for future rapid molecular diagnostics and antimicrobial stewardship.
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