The application of fiberoptic bronchoscope and alveolar lavage treatment on severe lung infection

Abstract

Objective To assess the diagnosis, therapeutic value and safety of the fiberoptic bronchoscope and alveolar lavage treatment on severe lung infection in PICU. Methods A total of 263 cases of severe lung infection that admitted to the PICU of Hu'nan Children's Hospital during March 1st, 2012 to February 28th, 2014 were retrospectively selected as bronchoscope treatment group, which underwent 327 times of bronchoscopy treatment.We also collected 108 children with lung infection whose family disagreed with fiberoptic bronchoscope treatment in the same period as the control group.Clinical manifestations and results of laboratory tests were compared between the bronchoscope treatment group and the control group. Results (1)Gram-negative bacterium was the mainly bacterial spectrum in bronchoalveolar lavage fluid of bronchoscope treatment group, and the culture-positive rate was 53.99%(142/263). (2)The mainly cause of repeated or refractory pneumonia or atelectasis was inflammation infection, accounting for 93.90%(231/246), the rate of airway abnormalities was 90.24%(222/246) when tracheobronchomalacia accounting for 76.58%(170/222). The primary lesions of airway were different significantly among different age groups(χ2=25.886, P=0.000). (3)The rate of tracheobronchomalacia in cases of congenital heart disease with pulmonary hypertension was 94.19%, which was significantly higher than those without pulmonary hypertension(38.09%)(P<0.05). (4)None serious complications happened to the children of bronchoscope treatment group.The clinical symptoms of fever, cough, breathing, pulmonary tribal sounds and atelectasis were relieved in bronchoscope treatment group compared with the control group.The inflammation indicators as C-reactive protein and procalcitonin decreased significantly in bronchoscope treatment group than those of control group(P<0.05), while PaO2, oxygenation index and SaO2 increased(P<0.05). Conclusion Fiberoptic bronchoscope and alveolar lavage treatment plays an important role on severe pulmonary infection, especially on refractory pneumonia or atelectasis.It not only can directly remove the sputum secretion in lung which could keep the airway unobstructed and shorten the course of diseases, but also can be an effective diagnostic means of airway dysplasia and foreign body in bronchus, and fiberoptic bronchoscope is safe and effective in PICU. Key words: Fiberoptic bronchoscope; Alveolar lavage; Lung infection; Children