Effects of bronchoalveolar lavage volume on arterial oxygenation in mechanically ventilated patients with pneumonia.
OBJECTIVE
To assess the effect of bronchoalveolar lavage (BAL) volume on arterial oxygenation in critically ill patients with pneumonia.


METHODS
Randomized clinical comparison.


METHODS
Six-bed respiratory intensive care unit of a 850-bed tertiary care university hospital.


METHODS
Thirty-seven intubated and mechanically ventilated patients with clinical suspicion of pneumonia.


METHODS
Bronchoscopically guided protected specimen brush (PSB) followed by either a "high volume" BAL (n = 16, protected catheter, mean volume: 131 +/- 14 ml) or a "low volume" BAL (n = 21, protected double-plugged catheter, 40 ml volume for all patients).


METHODS
Arterial oxygen tension/fractional inspired oxygen (PaO2/FIO2) and mean arterial pressure (MAP) before and up to 24 h after the intervention. Bacterial growth in quantitative cultures. Analysis of variance for repeated measurements with inter-subject factors.


RESULTS
All patients showed a lower PaO2/FIO2 ratio and higher MAP after the diagnostic procedure, without differences between the study arms (p = 0.608 and p = 0.967, respectively). Patients with significant bacterial growth (p = 0.014) and patients without preemptive antibiotic (p = 0.042) therapy showed a more profound and longer decrease in arterial oxygenation after the diagnostic procedure.


CONCLUSIONS
A decrease in the PaO2/FIO2 ratio was observed in all patients after a combined diagnostic procedure, independent of the BAL volume used. A significant bacterial burden recovered from the alveoli and no preemptive antibiotic therapy were associated with a larger and longer-lasting decrease in arterial oxygenation.
Bauer
T T
TT
Medizinische Klinik und Poliklinik, Abt. Pneumologie, Allergologie und Schlafmedizin, Bergmannsheil, Klinikum der Ruhr-Universität, Bochum, Germany.
Torres
A
A
Ewig
S
S
Hernández
C
C
Sanchez-Nieto
J M
JM
Xaubet
A
A
Agustí
C
C
Rodriguez-Roisin
R
R
D000704:Analysis of Variance; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D018893:Bronchoalveolar Lavage / Q000009:adverse effects*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy / Q000009:adverse effects; D016009:Chi-Square Distribution; D005336:Fiber Optic Technology; D006801:Humans; D007362:Intensive Care Units; D010100:Oxygen / Q000097:blood*; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D012121:Respiration, Artificial / Q000009:adverse effects
D010100:Oxygen