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Changes in respiratory mechanics after fiberoptic bronchoscopy with bronchoalveolar lavage in mechanically ventilated patients

Introduction

Nonuniform findings have been reported about the effects of bronchoalveolar lavage (BAL) on respiratory mechanics.

Objectives

(1) To study the effects of BAL on respiratory mechanics in mechanically ventilated patients with suspected pneumonia, and (2) to find out whether these effects are related to the extension of radiographic infiltrate and preceding respiratory mechanics measurements.

Methods

BAL was performed with 150 ml sterile isotonic saline in three aliquots of 50 ml. Respiratory mechanics (static compliance and airway resistance) was measured using the rapid airway occlusion technique immediately before and after the BAL and 90 minutes later. The heart rate, arterial blood pressure and body temperature were recorded continuously in all patients. Patients were classified according to the presence of unilateral or bilateral infiltrates.

Results

Fifty-eight critically ill patients undergoing mechanical ventilation were included. Following the BAL, compliance of the respiratory system (Crs) decreased from 50.9 ± 36.1 to 35.6 ± 14.8 ml/cmH2O (P < 0.01) and airway resistance increased from 16.2 ± 7.6 to 18.1 ± 11.3 cm H2O/l/seg (P < 0.05); 90 minutes later, both parameters had returned to pre-BAL values (P = not significant). Patients who showed >20% decrease in Crs had higher pre-BAL Crs than patients with less severe decrease (55.8 ± 20.1 vs 36.9 ± 14.1; P < 0.001). On the contrary, neither pre-BAL airway resistance nor the extension of the radiographic infiltrates were related to the changes in respiratory mechanics.

Conclusion

(1) BAL in mechanically ventilated patients can lead to a significant but transitory deterioration on pulmonary mechanics characterized by a decrease in Crs and an increase in airway resistance. (2) Patients with better initial Crs showed the more severe affectation.

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García, Á.E., Cano, A.G., Monrove, J.D. et al. Changes in respiratory mechanics after fiberoptic bronchoscopy with bronchoalveolar lavage in mechanically ventilated patients. Crit Care 11, P209 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5369

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Keywords

  • Bronchoalveolar Lavage
  • Isotonic Saline
  • Airway Resistance
  • Respiratory Mechanic
  • Static Compliance