title: Efficacy of selective intrabronchial air insufflation in acute lobar collapse.
abstract: Flexible fiberoptic bronchoscopy (FFB) to remove mucous plugs followed by selective intrabronchial air insufflation (SII) to expand the atelectatic lung was used in 17 surgical intensive care unit (SICU) patients with pulmonary lobar collapse. Thirteen patients were admitted for acute trauma, and the remainder were elderly postoperative patients. Lobar collapses occurred on SICU days 1 to 18 (mean +/- SEM: 5 +/- 1 days), and duration ranged from 4 to 258 hours (mean: 77 +/- 18 hours). Indications for FFB with SII included critical hypoxemia in 5 patients, worsening collapse in 2, and failure to respond to aggressive respiratory care in 10 (59%). FFB with SII was effective in 14 (82%) patients: 10 achieved full lung re-expansion, and 4 partial lung re-expansion. When lobar collapse was of less than 72 hours' duration, 92% (12 of 13) of patients had lungs re-expanded compared with 50% (2 of 4) whose collapse existed for more than 72 hours. The mean PaO2/FIO2 (fraction inspired oxygen) ratio was 135 +/- 18 prior to FFB with SII and increased to 205 +/- 21 after FFB with SII. Complications were minor and clinically insignificant. In conclusion, SII appears to be a simple, safe, effective adjunct to FFB in the treatment of SICU patients with pulmonary lobar collapse.
authors.affiliation: Department of Surgery, Denver General Hospital, University of Colorado Health Science Center 80204-4507.
authors.forename: J B
authors.initials: JB
authors.lastname: Haenel
authors.forename: F A
authors.initials: FA
authors.lastname: Moore
authors.forename: E E
authors.initials: EE
authors.lastname: Moore
authors.forename: R A
authors.initials: RA
authors.lastname: Read
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi; D001999:Bronchoscopy; D002648:Child; D002985:Clinical Protocols; D003422:Critical Care; D005100:Expectorants / Q000627:therapeutic use; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007327:Insufflation / Q000379:methods; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000188:drug therapy / Q000628:therapy*; D013396:Suction; D007507:Therapeutic Irrigation
chemical_list: D005100:Expectorants; D010100:Oxygen