Clinical study of the value in bronchoalveolar lavage in patients with severe lung infection by bed side painless fiberoptic bronchoscopy under chest CT guidance and mechanical ventilation / 中华急诊医学杂志

ABSTRACT

Objective To explore the effects of bed side painless fiberoptic bronchoscopy for bronchoalveolar lavage (BAL) under chest computed tomography (CT) guidance and mechanical ventilation in the patients with severe pulmonary infection (SPI).Methods A total of 131 cases of SPI undermechanical ventilation support were randomly (random number) divided into CT group (C group),chest Xray examination group (X group) and without radiological examination group (N group).The bronchoalveolar lavage (BAL) by using painless fiberoptic bronchoscopy with invasive mechanical ventilation was carried out in patients of these three groups.Vital signs and variables of respiratory mechanics ofpatients were monitored before and 1 h,2 h,and 4 h after BAL and the time consumed for BAL was simultaneous recorded.Meanwhile,infection related biomarkers on the 3rd d and 5thd after BAL,positive detection rate of pathogenic bacteria,the time of invasive mechanical ventilation used during BAL and total duration of mechanical ventilation support were measured.Results During BAL and at 10 min after BAL,heart rate and respiratory rate of C group and X group were lower than those of N group (P ＜ 0.05),however,there was no significant difference in SBP and DBP among groups (P ＞ 0.05).One and two hours after BAL,peak inspiratory pressure (PIP),work of breathing ventilation (WOBvent) and airway resistance (RAW) in C group and X group were lower than those in N group,therefore,dynamic compliance (Cdyn) in C and X groups was better than that in N group (P ＜0.05).Four hours after BAL.Cdyn in C group and X group was better than that in N group (P ＜ 0.05),But there were no significant differences in PIP,WOBvent and RAW among groups (P ＞ 0.05).BAL time (BAL-t) in C group (16.81 ±2.62) min was shorter than that in X group (20.12 ± 3.81) min and N group (23.69 ± 2.76) min,(P ＜ 0.05).Three and five days after BAL,core body temperature,WBC and procalcitonin (PCT) in C and X group were lower than those in N group (P ＜0.05),and those in C group was lower than those in X group (P ＜0.05).Pathogenic micro-organism detection rate in C group (80.55％,29/36) was higher than that in X group (72.09％,31/43) and N group (59.65％,34/57) (P ＜ 0.05).Total mechanical ventilation time (MV-t) in C group (114.36 ± 38.39) h was shorter than that in X group (132.07 ± 42.51) h and N group (165.28 ± 67.28) h (P ＜ 0.05).Conclusions BAL by using painless fiberoptic bronchoscopy under chest CT guidance can effectively reduce the stress on patients with severe pulmonary infection supported with mechanical ventilation,decrease airway hyper-reactivity,shorten the BAL time,ICU stay and duration of mechanical ventilation,facilitate drainage of lung infection exudates and pathogen detection rate and improve efficacy of comprehensive treatment.