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.