Selective medicated (saline + natural surfactant) bronchoalveolar lavage in unilateral lung contusion. A clinical randomized controlled trial.
OBJECTIVE
Open lung and low tidal volume ventilation appear to be a promising ventilation for chest trauma as it can reduce ARDS and improve outcome. Local therapy (e.g. BAL) can be synergic to remove from the lung the debris, mitigate inflammatory cascade and avoid damage spreading to not compromised lung areas.


METHODS
44 pulmonary contused patients were randomized to receive broncho-suction and volume controlled low tidal volume ventilation-VCLTVV (Control Group) or the same ventilation plus medicated (saline + surfactant) BAL (Treatment Group). Tidal volume <10 ml/kg, PEEP of 10-12 cm H(2)O and PaO(2) 60-100 mm Hg and PaCO(2) 35-45 mm Hg were used in both groups. BAL was performed using a fiberscope. 4 boluses of 25 ml saline with 2.4 mg/ml of surfactant were introduced into each contused lobe in which, subsequently, 240 mg of surfactant was instilled.


RESULTS
All patients survived. In the Control Group 18 patients developed pneumonia, 5 ARDS and days of intubation were 11.50 (3.83) compared to 5.05 (1.21) of Treatment Group in which OI and PaO(2)/FiO(2) significantly improved from 36 h.


CONCLUSIONS
VCLTVV alone was not able to prevent ARDS and infection in the Control Group as the reduction of intubation. In the Treatment Group, VCLTVV and medicated BAL facilitated the removal of degradated lung material and recruited the contused lung regions, enabling the healing of the lung pathology.
Marraro
Giuseppe A
GA
Anesthesia and Intensive Care Department, A.O. Fatebenefratelli and Ophthalmiatric Hospital, Milan, Italy. gmarraro@picu.it
Denaro
Carmelo
C
Spada
Claudio
C
Luchetti
Marco
M
Giansiracusa
Carla
C
D055371:Acute Lung Injury / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D018893:Bronchoalveolar Lavage / Q000379:methods*; D003288:Contusions / Q000503:physiopathology / Q000628:therapy*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000517:prevention & control; D011175:Positive-Pressure Respiration; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000517:prevention & control; D012965:Sodium Chloride / Q000008:administration & dosage*; D013396:Suction; D013990:Tidal Volume; D055815:Young Adult
D011663:Pulmonary Surfactants; D012965:Sodium Chloride