{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T16:28:56Z","timestamp":1794241736255,"version":"4.9.0"},"reference-count":12,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"unspecified","delay-in-days":30,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Ambu A\/S Ltd","award":["no award\/grant number"],"award-info":[{"award-number":["no award\/grant number"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,8,8]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bronchial washing can be inefficient or unsafe due to aerosolisation, poor yield and loss of sample. The setup and connectivity of sampling containers is often challenging. Furthermore, the process of bronchoscopy in the intensive care unit is inadequately reported.<\/jats:p>\n                    <jats:p>We tested whether a novel closed bronchoscopy sampling system is safer and more efficient than the standard sampling technique. We recorded variation in bronchoscopy practice in mechanically ventilated patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicentre randomised controlled trial saw 188 bronchoscopies performed in mechanically ventilated patients requiring diagnostic sampling. The closed-system Ambu bronchosampler (ABS) was compared to standard sampling containers (SSC) with single-use bronchoscopes (Ambu A4) for primary outcomes of safety (spill, unplanned disconnection) and efficiency (ease of connectivity, setup, loss of sample and % volume retrieved), secondary efficiency outcomes and the tertiary outcomes of the bronchoscopy process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ABS was safer than SSC; spills 0%\u2009versus 23.7% (0\/94 vs 22\/93), p&lt;0.001; unplanned tube disconnections 5.3%\u2009vs 21.3% (5\/95 vs 20\/93), p&lt;0.001; unplanned container disconnections 2.1%\u2009vs 7.5% (2\/95 vs 7\/93), p=0.08. Efficiency was significantly higher in ABS than SSC (acceptable\/(very) easy) setup 98.9%\u2009vs 82.8% (94\/95 vs 77\/93), connectivity 100%\u2009vs 54.7% (88\/88 vs 47\/86), upright 98.9%\u2009vs 10.8% (94\/95 vs 10\/93) and sample loss 11.6%\u2009vs 48.4% (11\/95 vs 45\/93), all p&lt;0.001. Volume retrieved percentage unchanged (33.0%\u2009vs 35.4%, p&gt;0.2).<\/jats:p>\n                    <jats:p>Bronchoscopy for infection in 80.9%, therapeutic lavage in 51% and infrequently otherwise. Prior imaging in 93.2%, preprocedural checklists\/timeouts in 83.5% and post-procedure chest X-rays in 78.2%.<\/jats:p>\n                    <jats:p>Mandatory ventilation was most common peribronchoscopy. Neuromuscular blockade in 73.8% and recruitment manoeuvres in 34.7%. The bronchoscope was not removed intraprocedurally in 80.2% of cases. Positive microbiology was found in 45.7% of samples. Adverse events were rare (&lt;5%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Closed-system bronchoscopic sampling was safer (less spill and unplanned disconnections) and more efficient (setup, connectivity and loss prevention) than standard containers. Closed-system diagnostic sampling devices should be the standard during bronchoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05964075\">NCT05964075<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2026-004249","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:40:17Z","timestamp":1788176417000},"page":"e004249","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Randomised controlled trial to assess the safety and efficiency of a self-contained sampling device\/disposable bronchoscope system versus usual sampling procedure (RASECAL)"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct05964075","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05964075","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3219-8966","authenticated-orcid":false,"given":"Suveer","family":"Singh","sequence":"first","affiliation":[{"name":"Respiratory and Intensive Care Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"},{"name":"Adult Intensive Care, Royal Brompton Hospital, London, UK"},{"name":"Guy\u2019s and St Thomas\u2019 NHS Foundation Trust (NHSFT), Royal Brompton Hospital, London, UK"},{"name":"APMIC, Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeet","family":"Chana","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Mcentee","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaladerhan","family":"Agbontaen","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Athayde","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Royal Brompton Hospital, London, UK"},{"name":"Guy\u2019s and St Thomas\u2019 NHS Foundation Trust (NHSFT), Royal Brompton Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Creagh-Brown","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Royal Surrey NHS Foundation Trust, Guildford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilshad","family":"Valliani","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Carungcong","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Martins","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Costa","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Al Hindawi","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, University College Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vimal","family":"Grover","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Royal Marsden Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4930-666X","authenticated-orcid":false,"given":"David Robert","family":"Woods","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Royal Brompton Hospital, London, UK"},{"name":"Guy\u2019s and St Thomas\u2019 NHS Foundation Trust (NHSFT), Royal Brompton Hospital, London, UK"},{"name":"Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1846-9160","authenticated-orcid":false,"given":"David Benjamin","family":"Antcliffe","sequence":"additional","affiliation":[{"name":"APMIC, Surgery and Cancer, Imperial College London, London, UK"},{"name":"Intensive Care Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Smart","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisham","family":"Said","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, West Middlesex University Hospital, Isleworth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Popescu","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, West Middlesex University Hospital, Isleworth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Garfield","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Royal Brompton Hospital, London, UK"},{"name":"Guy\u2019s and St Thomas\u2019 NHS Foundation Trust (NHSFT), Royal Brompton Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Ong","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Royal Brompton Hospital, London, UK"},{"name":"Guy\u2019s and St Thomas\u2019 NHS Foundation Trust (NHSFT), Royal Brompton Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Cangialosi","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Royal Brompton Hospital, London, UK"},{"name":"Guy\u2019s and St Thomas\u2019 NHS Foundation Trust (NHSFT), Royal Brompton Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Leal","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Royal Brompton Hospital, London, UK"},{"name":"Guy\u2019s and St Thomas\u2019 NHS Foundation Trust (NHSFT), Royal Brompton Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Russell","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Royal Brompton Hospital, London, UK"},{"name":"Guy\u2019s and St Thomas\u2019 NHS Foundation Trust (NHSFT), Royal Brompton Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Templeman","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Royal Brompton Hospital, London, UK"},{"name":"Guy\u2019s and St Thomas\u2019 NHS Foundation Trust (NHSFT), Royal Brompton Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Sissons","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagdish","family":"Sokhi","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linsey","family":"Christie","sequence":"additional","affiliation":[{"name":"Adult Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Davies","sequence":"additional","affiliation":[{"name":"APMIC, Surgery and Cancer, Imperial College London, London, UK"},{"name":"Adult Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"2026110908051314000_13.1.e004249.1","first-page":"62","article-title":"Bronchofiberscopy","volume":"111","author":"Sackner","year":"1975","journal-title":"Am Rev Respir Dis"},{"key":"2026110908051314000_13.1.e004249.2","doi-asserted-by":"crossref","unstructured":"Singh S . Bronchoscopy in critical care. In: Singh S , Pelosi P , Conway Morris A , eds. Oxford textbook of respiratory critical care. OUP, 2023.","DOI":"10.1093\/med\/9780198766438.001.0001"},{"key":"2026110908051314000_13.1.e004249.3","unstructured":"World Health Organisation . Infection prevention and control during health care when COVID-19 is suspected.interim guidance. 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Press, 1939."},{"key":"2026110908051314000_13.1.e004249.7","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2020.04.32"},{"key":"2026110908051314000_13.1.e004249.8","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202004-0945LE"},{"key":"2026110908051314000_13.1.e004249.9","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/j.jcrc.2014.06.006","article-title":"Safety of research bronchoscopy in critically ill patients","volume":"29","author":"Prebil","year":"2014","journal-title":"J Crit Care"},{"key":"2026110908051314000_13.1.e004249.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12890-015-0104-1","article-title":"Clinical course and complications following diagnostic bronchoalveolar lavage in critically ill mechanically ventilated patients","volume":"15","author":"Schnabel","year":"2015","journal-title":"BMC Pulm Med"},{"key":"2026110908051314000_13.1.e004249.11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa0810119"},{"key":"2026110908051314000_13.1.e004249.12","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1111\/anae.13622","article-title":"Contamination of single-use bronchoscopes in critically ill patients","volume":"72","author":"McGrath","year":"2017","journal-title":"Anaesthesia"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2026-004249","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T16:05:21Z","timestamp":1794240321000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2026-004249"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,8,31]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bmjresp-2026-004249"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2026-004249","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}