Bain William, Sarma Aartik, Morales-Nebreda Luisa, Rizzo Alicia N, Herron Malcolm, Wright Shelton W, Hagan Robert S, Vigeland Christine L, Mwizerwa Erin, Pickens Chiagozie, Toth Susan, Nonoyama Mika, Cao Bin, Luna Carlos M, Rubin Eileen, Torres Antoni, Bos Lieuwe D, McVerry Bryan J, Restrepo Marcos I, Baron Rebecca M, Ware Lorraine B, Kulkarni Hrishikesh S, Calfee Carolyn S, Rogers Angela J, Wunderink Richard G, Varisco Brian M, Dela Cruz Charles S, Kitsios Georgios D, Mock Jason R, Morrell Eric D, McElvaney Noel G, Bastarache Julie A
Ann Am Thorac Soc. 2025 Aug;22(8):1101-1114. doi: 10.1513/AnnalsATS.202505-543ST.
Research using lower respiratory tract (LRT) sampling may lead to improved understanding and management of patients with acute respiratory failure (ARF). Research bronchoscopy is a valuable tool for sampling the LRT during ARF. However, bronchoscopy may be limited by challenges with repeated sampling, the inability to sample the most severely ill patients, and increased resource utilization. "Noninvasive" sampling strategies, such as nonbronchoscopic bronchoalveolar lavage, endotracheal aspirate collection, and heat moisture exchange filter fluid collection, may expand the opportunity to collect LRT samples for research. Upper respiratory tract and sputum sampling may enable sampling in nonintubated patients with ARF, for whom there is no direct noninvasive access to the LRT. We convened a workshop with 32 experts from diverse continents, scientific backgrounds, and healthcare professions, all with experience in clinical or research practice during ARF. The Workshop goals were to review existing noninvasive sampling methods, evaluate their respective potential benefits and limitations, and identify future research priorities aimed at improving standardization and integration of these approaches into practice. Findings were generated by review of literature, expert presentations, meeting discussions, and electronic surveys using a modified Delphi approach. Participants agreed that each sampling method provides biologically meaningful data during ARF while also acknowledging that each method has benefits and limitations. Various potential advantages to noninvasive methods include reduced cost, enhanced speed, and ease of adoption compared with standard fiberoptic bronchoscopy. Despite the potential advantages, rigorous head-to-head comparisons between noninvasive methods and/or standard bronchoscopy are limited, which is a priority for future research. Additional research priorities include examination of the feasibility and benefit of serial sampling of the LRT and investigation of how LRT biomarkers are related to lung pathophysiology and patient-centered clinical outcomes during ARF. This Workshop Report provides guidance for investigators to integrate LRT sampling into their research and highlights key priorities, such as rigorous head-to-head comparison of sampling methods for research, to improve the standardization of noninvasive sampling methods and use of LRT sampling in research and clinical practice.
使用下呼吸道（LRT）采样的研究可能有助于提高对急性呼吸衰竭（ARF）患者的理解和管理水平。研究性支气管镜检查是在ARF期间对LRT进行采样的一种有价值的工具。然而，支气管镜检查可能受到重复采样的挑战、无法对病情最严重的患者进行采样以及资源利用增加的限制。“非侵入性”采样策略，如非支气管镜下支气管肺泡灌洗、气管内吸出物采集和热湿交换过滤器液体采集，可能会扩大为研究采集LRT样本的机会。上呼吸道和痰液采样可以使未插管的ARF患者进行采样，对于这些患者而言，无法直接通过非侵入性方法获取LRT样本。我们召集了一个由来自不同大陆、具有不同科学背景和医疗专业的32位专家组成的研讨会，所有专家都有在ARF期间进行临床或研究实践的经验。研讨会的目标是回顾现有的非侵入性采样方法，评估它们各自的潜在益处和局限性，并确定未来的研究重点，以提高这些方法的标准化程度并将其整合到实践中。通过文献综述、专家报告、会议讨论以及采用改良德尔菲法的电子调查得出了研究结果。参与者一致认为，每种采样方法在ARF期间都能提供具有生物学意义的数据，同时也承认每种方法都有其益处和局限性。与标准纤维支气管镜检查相比，非侵入性方法的各种潜在优势包括成本降低、速度提高和易于采用。尽管有潜在优势，但非侵入性方法与标准支气管镜检查之间严格的直接比较有限，这是未来研究的一个重点。其他研究重点包括检查LRT连续采样的可行性和益处，以及研究在ARF期间LRT生物标志物如何与肺病理生理学和以患者为中心的临床结果相关联。本研讨会报告为研究人员将LRT采样整合到其研究中提供了指导，并突出了关键重点，如对研究采样方法进行严格的直接比较，以提高非侵入性采样方法的标准化程度以及在研究和临床实践中使用LRT采样。
