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Optical coherence tomography (OCT) in patients with acute respiratory failure on the ICU

Introduction: Differentiating ARDS from other forms of respiratory failure can be difficult. By advancing an optic fiber through a diagnostic bronchoscope, followed by an automatic pullback mechanism, OCT enables real-time 3D imaging of the alveolar compartment and peripheral airways. Aim: To investigate feasibility of bronchoscopic OCT, and to describe different OCT patterns of the alveolar compartment in mechanically ventilated patients. Methods: Observational study of OCT imaging in mechanically ventilated patients for non-resolving acute respiratory failure with an indication for diagnostic bronchoscopy. Results: 9 patients were included with clinical features of acute respiratory failure and bilateral pulmonary infiltrates not fully explained by cardiac failure (ARDS). Dominant CT patterns were ground glass(n=4), consolidation(n=3), reticulation(n=1), other(n=1). Total of 47 pullbacks were obtained without adverse events. Different patterns of the alveolar compartment (normal, alveolar filling, thickening of alveolar septae, loss of normal architecture of alveolar septae) were identified (Figure 1). Conclusions: This is the first study to show feasibility and safety of OCT imaging of alveolar compartment in mechanically ventilated patients. We identified different patterns, which could be helpful in the future to differentiate various causes of respiratory failure.