Comparison of ventilatory effects between three-way laryngeal mask airway and tracheal catheter on patients during bronchoalveolar lavage / 中华急诊医学杂志

Objective To compare the ventilatory effects between three-way laryngeal mask airway (TLMA)and tracheal catheter (TC) on hemodynamics, respiratory function and stress responses on patients during bronchoalveolar lavage (BAL). Method Forty patients scheduled for BAL under general anesthesia were divided (stratified sampling) into either TLMA group (group T,n = 20) or TC group (group C, n = 20) according to the stratified sampling principle. SpO2, SBP, DBP and HR were measured in 5 min after entering the operating theater (To), just before inserting TLMA or TC(T1), immediately after inserting TLMA or TC(T2) ,3 min(T3), 5 min(T4), 10 min(T5)after mechanical ventilation, 10 min(T6),20 min(T7), 30 min(T8)during the course of BAL,immediately after extubating TLMA or TC (T9)and 3 min after extubating TLMA or TC (T10). The tidal volume (VT), peak inspiratory airway pressure (Ppeak) and end expiratory CO2 pressure(PETCO2)were recorded at T2,T4,T6,T7, T8, T10. The venous blood samples were taken at T0, T2, T3, T4, T6, T9, T10 for the measurements of epinephrine(AE), norepinephrine(NE)and dopamine (DA) levels with high performance liquid chromatography.Data were dealt with SPSS version 10.0 statistic software. The variables of hemodynamics and stress responses were analyzed with ANOVA of repeating test data. P ＜ 0.05 means the difference in statistical significance. Results In group C, SBP, DBP and HR were significantly higher than those in group T at T2 ,T3 ,T9 (P ＜ 0.05). In group C, the levels of Ppeak were significantly higher than those in group T at T6 ,T7 ,T8 (P ＜ 0.05), and the concentrations of AE, NE and DA were also significantly higher in group C than those in group T at T2, T3 and T9 (P ＜0.05). Conclusions Ventilation with TLMA in patients during BAL is better than TC in respects of keeping stable ventilation, stable hemodynamics and producing less stress responses.

Implication of quantitative culture of bronchoalveolar lavage fluid in the diagnosis of ventilator assocaited pneumonia in patients with antimicrobial therapy / 결핵

BACKGROUNDS: Authors evaluated the quantitative culture of bronchoalveolar lavage fluid(BALF) in patients who were being treated with antimicrobial agents and the characteristics of isolated microorganism. METHOD: A prospective study was done with 25 patients under mechanical ventilation and antimicrobial treatment in ICU and NCU of Yongdong Severance Hospital from Apr. to Sep. 1999. Patients were classified into two groups: control group (n=5) and patients with VAP (n=20). The threshold of quantitative culture of BAL fluid in the diagnosis of VAP was 104 cfu/ml. RESULTS: 1) In gram staining of BALF, one patient in the control group and four in the VAP group showed positive results. Quantitative culture of BALF showed no organisms in the patients in the control group and in 9 VAP patients. Therefore the overall sensitivity was 43.8%. 2) Frequency of isolated organisms cultured above diagnostic threshold was in the following other : E. cloacae, S. aureus, K. pneumoniae, and A. baumani. S. aureus and Staphylococcus coagulase(-) were all resistant to oxacillin. Seven out of 10 isolated G (-) organisms were suspected to be organisms producing extended spectrum β-lactamase (ESBL). 3) The concurrence between gram staining of sputum aspiration and that of BALF was only in 1 case. And the concurrence of culture results was observed in 3 cases. CONCLUSION: The sensitivity of gram staining and quantitative culture of BALF from patients under antibiotic therapy and the concordance rate between conventional tracheal aspiration and BAL were low, facts which were important in interpretation the data. Since the frequency of drug resistance organisms was not different from that of foreign data, antibiotics must be prudently selected and used.

Clinical Effect of Bronchoalveolar Lavage in Ventilated Preterm Infants

PURPOSE: Bronchoalveolar lavage (BAL) in ventilated neonates is a modification of routine endotracheal suction and is a potentially useful technique in studying the evolution and resolution of pulmonary inflammation. Therefore, this study is designed to investigate the effects of BAL on blood gases, blood pressure and heart rate in ventilated newborn infants with respiratory disease. METHODS: Fourteen premature infants were lavaged and all were intubated for respiratory distress syndrome and ventilated by a pressure-limited ventilator. Heart rate and mean arterial blood pressure were recorded during a 3 minute pre-lavage period and then for 5 minutes after the procedure. Arterial blood gases were obtained from an indwelling arterial catheter immediately before and 1 minute after BAL. RESULTS: Clinically significant hypoxemia (200/min) or bradycardia (<110/min) were not induced in any infant. Heart rate and mean arterial blood pressure tended to increase at 1 minute post- BAL and those recovered completely within 5 minutes post-BAL. Readings of transcutaneous oxygen obtained from the 14 infants showed to be recovered completely within 4 minutes post- BAL. CONCLUSION: These changes appear to be qualitatively and quantitatively similar to those described after routine endotracheal suction.

The Usefulness of Quantitative Culture of Bronchoalveolar Lavage Fluid in the Diagnosis of Bacterial Pneumonia / 대한내과학회지

BACKGROUND: The aim of this study is to evaluate the usefulness of quantitative culture of bronchoalveolar lavage(BAL) fluid for the diagnosis of bacterial pneumonia and identification of causative agents. METHODS: Study group consisted of 30 episodes in 28 patients, enrolled from January 1995 through June 1996. Inclusion criteria were 1) presence of respiratory symptoms such as cough, sputum or dyspnea 2) increased peripheral blood leukocyte count(> or =11,000/mm3) 3) Fever(> or =38.3 degrees C) 4) purulent sputum 5) new or progressive infiltrate on chest radiography. For the diagnosis of pneumonia and its causative agents, sputum smear and culture, blood culture and BAL fluid studies were performed. BAL fluid studies included differential count of white blood cell, BAL fluid smear and culture, detection of elastin fibers and presence of intracellular organisms(ICO). Quantitative culture of BAL fluid was considered positive if colony-forming units was more than 1.0 x 104/ml. Positive criteria for ICO was presence of microorganism in more than five per 100 of phagocytes. RESULT: Recruited were 22 males and 6 females. The mean age was 57.5+/-13.5 years(range 25-84). Of 30 episodes underwent BAL fluid studies, 19 cases were diagnosed to be bacterial pneumonia. S. aureus(7 cases) was the most common causative agent and was followed by P. aeruginosa(4), E. cloacae(2), A. baumanii(1), H. influenzae(1) and -hemolytic Streptococcus(1). Sensitivity of quantitative culture of BAL fluid for the diagnosis of bacterial pneumonia was 68.4% and its specificity was 63.6%. Elastin fibers were detected in 5 cases(31%) and ICO over 5% in 3 cases(15.7%). When criteria of quantitative culture of BAL fluid, detection of ICO and elastin fibers were applied together, diagnostic rate of pneumonia was 84.2%(16/19). CONCLUSON: Quantitative culture of BAL fluid was more sensive and specific compared to sputum and blood culture for the diagnosis of bacterial pneumonia. It was suggested that detection of ICO and elastic fibers in BAL fluid could raise the diagnostic rate of bacterial pneumonia.

Pulmonary Oxygen Toxicity in Rats: Changes of Lung Clearance of 99mTc-DTPA and Bronchoalveloar Lavage / 대한마취과학회지

Animal study was performed to determine the changes in rat lung permeability in hyperoxic condition. 3 groups of rats (n=8 each) were exposed to 100% oxygen for 24 hr(group 2), 48 hr(group 3) and 72 hr(group 4), respectively, and compared with control (group 1 at room air, n=8). The time course of development of solute flux was evaluated by the clearance of 99mTc-labeled diethylenetriamine pentaacetate ( 99mTc-DTPA) from the lung, Afterwards, bronchoalveolar lavage (BAL) was performed to measure the concentration of albumin and determine the evidence of cell injury and inflammation in lung. BAL fluids were analyzed to determine several markers of cell injury and inflammation including total and differential cell counts, lactate dehydrogenase (LD), alkaline phosphatase (ALP), extracellular potassium (K+) and globulin (total protein minus albumin). 99mTc-DTPA clearance was significantly increased by exposure for 48 hours of hyperoxia. Albumin concentration ratio (BAL albumin concentration divided by serum albumin concentration) was increased sharply after 48 hr. Significant changes in WBC counts and differential counts were not found until 48 hr of hyperoxia. Elevated LD concentration was observed at 48 hr and thereafter, and ALP, K+, and globulin concentration ratio (BAL globulin /serum globulin) was significantly high only in group 4. Mortality was not observed until 72 hr when 3 of 8 rats were dead. It is concluded that significant 99mTc-DTPA clearance, and cellular and biochemical findings of BAL could not be observed until 48 hr in rats exposed to 100 % oxygen.