Marraro Giuseppe A, Luchetti Marco, Spada Claudio, Galassini Elena, Giossi Massimo, Piero Alessandro Monici Preti
Anesthesia and Intensive Care Department, Pediatric Intensive Care Unit, Fatebenefratelli and Ophtalmiatric Hospital, Milan, Italy.
Pediatr Crit Care Med. 2007 Sep;8(5):476-81. doi: 10.1097/01.PCC.0000282158.09783.7C.
To study the ability of volume-controlled ventilation and medicated (normal saline plus surfactant) bronchoalveolar lavage in aspiration to reduce the duration of intubation and improve gas exchange.
: Randomized controlled clinical trial.
Pediatric intensive care unit.
Twenty children, 1 month to 16 yrs old, who were intubated and mechanically ventilated, were randomized within 6 hrs of aspiration to receive volume-controlled ventilation plus medicated bronchoalveolar lavage (treatment group) or the same ventilation and bronchosuction (control group).
Volume-controlled ventilation and positive end-expiratory pressure (10-12 cm H2O) were applied. Medicated bronchoalveolar lavage was performed using five aliquots of 5 mL of saline plus 10 mg/mL Curosurf (porcine surfactant, Chiesi Pharmaceutical SpA, Parma, Italy) in infants, five boluses of 10 mL of saline plus 5 mg/mL Curosurf in children, and four boluses of 25 mL of saline with 2.4 mg/mL Curosurf in adolescents for each affected lobe. One hour after bronchoalveolar lavage, 240 mg of Curosurf was administered locally.
All patients survived. In the treatment group, days of intubation were 4.6 (+/-1.07), oxygenation index and Pao2/Fio2 improved significantly at 24 hrs, and statistical reduction in tidal volume mL/kg was observed from 36 hrs. In the control group, days of intubation were 11.8 (+/-3.22) (p < .0001), no improvement in oxygenation was noted, and pneumonia was observed in seven children (70%).
Even though this was an unblinded small clinical trial and low tidal volume strategy was not employed at an early stage after lung injury, there is some evidence that bronchoalveolar lavage with normal saline and surfactant may have clinical value in treating severe aspiration syndrome in children. More clinical studies are warranted to overcome study limitations and potential bias.
研究容量控制通气联合药物（生理盐水加表面活性剂）支气管肺泡灌洗术在误吸治疗中减少插管时间和改善气体交换的能力。
随机对照临床试验。
儿科重症监护病房。
20名年龄在1个月至16岁之间、已插管并接受机械通气的儿童，在误吸后6小时内随机分组，分别接受容量控制通气联合药物支气管肺泡灌洗术（治疗组）或相同通气及支气管抽吸术（对照组）。
采用容量控制通气和呼气末正压（10 - 12厘米水柱）。婴儿使用五份5毫升生理盐水加10毫克/毫升珂立苏（猪肺表面活性剂，意大利奇西制药公司，帕尔马）进行药物支气管肺泡灌洗，儿童使用五剂10毫升生理盐水加5毫克/毫升珂立苏，青少年每个受累肺叶使用四剂25毫升含2.4毫克/毫升珂立苏的生理盐水。支气管肺泡灌洗术后1小时，局部给予240毫克珂立苏。
所有患者均存活。治疗组插管天数为4.6（±1.07）天，24小时时氧合指数和动脉血氧分压/吸入氧分数值显著改善，36小时时潮气量毫升/千克有统计学意义的降低。对照组插管天数为11.8（±3.22）天（p < 0.0001），未观察到氧合改善，7名儿童（70%）发生肺炎。
尽管这是一项非盲法小型临床试验，且在肺损伤早期未采用低潮气量策略，但有证据表明生理盐水和表面活性剂支气管肺泡灌洗术在治疗儿童严重误吸综合征方面可能具有临床价值。需要更多临床研究来克服研究局限性和潜在偏倚。
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