Mini-bronchoalveolar lavage with and without surfactant in the treatment of recurrent atelectasis in pediatric intensive care patients

Introduction

Since traditional treatment of atelectasis is often insufficient to reopen the collapsed airways, mini-bronchoalveolar lavage (mini-BAL) is performed. We retrospectively compared the treatment effects of mini-BAL only and mini-BAL combined with surfactant in the treatment of pediatric ICU patients with recurrent atelectasis.

Methods

A retrospective analysis included a heterogeneous group of 18 mechanically ventilated pediatric ICU patients with recurrent atelectasis. Nine patients (mean age, 4.4 ± 3.4 years) who received surfactant after standard mini-BAL were compared with nine patients (mean age, 4.7 ± 3.0 years) who underwent only standard mini-BAL. Gas exchange and pulmonary mechanic parameters in the two groups were compared. The peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), paO₂/FiO₂, and partial arterial carbon dioxide pressure (paCO₂) were analyzed with 3 × 2 multivariate analysis of variance, with the time of measurement (before treatment, 6 and 12 hours after treatment) as a within-subject factor and the type of treatment (mini-BAL only vs mini-BAL with surfactant) as a between-subject factor.

Results

The groups did not differ in age (independent sample t test = 0.698). The parameters significantly changed with time after treatment (Wilks' λ = 0.027, F = 25.277, P < 0.001), and the treatment procedures had significantly different effects (time × treatment, Wilks' λ = 0.103, F = 6.070, P = 0.013). A significant univariate time-treatment interaction was not present only for SpO₂ (F(2,32) = 2.167, P = 0.629). Subsequent analyses showed different effect of surfactant administration on PEEP compared with mini-BAL alone. In the mini-BAL only group, PEEP changed from 6.44 ± 1.13 cmH₂O before treatment to 5.22 ± 0.83 cmH₂O 6 hours after the treatment (P = 0.019), and remained the same 12 hours after the treatment. The group that received surfactant had significantly lower PEEP values compared with the mini-BAL only group 12 hours after the treatment (3.44 ± 0.72 before vs 5.22 ± 0.44 mmH₂O after treatment, P = 0.025).

Conclusion

Mini-BAL is efficient in the treatment of recurrent atelectasis in pediatric ICU patients. Beneficial effects of surfactant administration after mini-BAL should be confirmed prospectively in a larger number of patients.