Intensive Care Med 1998 Dec;24(12):1289-93
Changes in pulmonary mechanics after fiberoptic bronchoalveolar lavage in
mechanically ventilated patients.
Klein U, Karzai W, Zimmermann P, Hannemann U, Koschel U, Brunner JX, Remde H.
Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller
University Jena, Germany.
OBJECTIVE: We prospectively assessed the impact of bronchoalveolar lavage (BAL)
on respiratory mechanics in critically ill, mechanically ventilated patients.
STUDY DESIGN: Mechanically ventilated patients underwent BAL of one lung segment
using 5 x 20 ml of sterile, physiologic saline with a temperature of 25-28
degrees C. The fractional inspired oxygen was increased to 1.0, but ventilator
settings were otherwise left unchanged. Static pulmonary compliance, pulmonary
resistance, alveolar ventilation, and serial dead space were measured 60 min and
2 min before and 8, 60, and 180 min after BAL to assess the consequences of the
procedure. In addition, blood gases [partial pressure of carbon dioxide in
arterial blood (PaCO2) and arterial oxygen tension (PaO2)], hemodynamic
variables (heart rate, systolic and diastolic blood pressure), and body
temperature were recorded at the same time points. SETTING: Intensive care unit
of a university hospital. PATIENTS: 18 consecutive critically ill, mechanically
ventilated patients. RESULTS: Pulmonary compliance decreased by 23% (p < 0.05)
and pulmonary resistance increased by 22% (p < 0.05) shortly after BAL. The
changes in pulmonary compliance and resistance were more than 30% in one third
of the patient population. One hour after the procedure, PaO2 was significantly
lower and PaCO2 significantly higher than before the procedure. Three hours
after the procedure, pulmonary resistance returned to pre-BAL values but
compliance remained 10% below baseline values (p < 0.05). CONCLUSION: BAL in
mechanically ventilated patients is associated with deterioration of pulmonary
mechanics and function.