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Cardiopulmonary effects of bronchoalveolar lavage in critically ill patients with ventilator-associated pneumonia

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Purpose

The purpose of this study was to evaluate the cardiopulmonary effects of bronchoalveolar lavage (BAL) in critically ill patients with ventilator-associated pneumonia (vap).

Method

Ten sedated and paralyzed critically ill patients suspected of having vap and requiring invasive hemodynamic monitoring were studied. A pulmonary artery catheter with continuous SvO2 and CO display was inserted to titrate administration of fluids and vasopressors. The FiO2 was adjusted to 1.0, 30 min before the performance of BAL for bacteriologic diagnosis and remained at this level for 6 h after the procedure. The following parameters were determined (1) before, (2) immediately after, (3) 2 h after and (4) 6 h after the BAL: compliance, Ppeak, Pplat, Pi, Rsmax, Rsmin, Δ Rs, PO2, PCO2, pH, SaO2, SvO2, AP(S/D/M), PAP(S/D/M), CVP, PCWP, CI, heart rate,PVRI, SVRI, LVSWI, RVSWI, DO2I, VO2I, CcO2, CaO2, CvO2, C(a-v)O2, Δ PCO2, O2ER, Qs/Qt.

The paired t-test method was used to compare the results at the four different time frames. Patients with necessary manipulation in the infusion rate of fluids-vasopressors and/or the parameters of mechanical ventilation during the 6 h period were excluded from data analysis.

Results

The results of eight patients were analyzed. Compliance showed after a nonsignificant fall from (1) to (2), an increase from (2) to (3) (P=0.038) and from (2) to (4) (P=0.017). Pplat increased slightly from (1) to (2) and decreased afterwards significantly from (2) to (4) (P=0.017). PCO2 increased from (1) to (2) (P=0.015) and remained high afterwards with parallel drop in pH from (1) to (2) (P=0.006). The CI showed, after a fall from (1) to (3) (P=0.031), a gradual improvement. PVRI demonstrated, after a nonsignificant fall from (1) to (2), a gradual increase after (2) which was significant at (4) (P=0.026). No further significant differences were recognized in every other parameter studied.

Conclusions

BAL in our patient population was a safe procedure. It did not affect oxygenation and pulmonary shunt. Compliance and Pplat showed after a nonsignificant initial deterioration gradual improvement. The delayed fall of CI did not persist at the end of the study. The increase in PVRI needs further evaluation.

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Koroneos, A., Kalomenidis, I., Moraitou, F. et al. Cardiopulmonary effects of bronchoalveolar lavage in critically ill patients with ventilator-associated pneumonia. Crit Care 4, P97 (2000). https://doi.org/10.1186/cc817

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Keywords

  • Pulmonary Artery
  • Mechanical Ventilation
  • Infusion Rate
  • Full Text
  • Bronchoalveolar Lavage