Matsumoto Takafumi, Sato Yoko, Fukuda Satoshi, Katayama Shinshu, Miyazaki Yuya, Ozaki Makoto, Kotani Toru
Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, Japan.
Intern Med. 2015;54(7):731-5. doi: 10.2169/internalmedicine.54.2686. Epub 2015 Apr 1.
Objective Fibre-optic bronchoscopy with bronchoalveolar lavage (FOB-BAL) is an important tool for diagnosing and selecting treatment for acutely hypoxaemic patients with diffuse lung infiltrates. However, FOB-BAL carries a risk of significant hypoxaemia and subsequent tracheal intubation during and after the procedure. The application of FOB-BAL using a laryngeal mask airway (LMA) in combination with continuous positive airway pressure (CPAP) may minimize the incidence of hypoxaemia; however, the safety and efficacy of this procedure have not been investigated. Methods A retrospective chart review was performed from April to September 2013. Data regarding the recovered volume of BAL fluid, incidence of tracheal intubation within eight hours after the completion of FOB-BAL, respiratory and haemodynamic parameters and treatment modifications were collected for the evaluation. Results Ten trials of FOB-BAL using an LMA and CPAP were performed in nine patients with severe acute hypoxaemia associated with diffuse lung infiltrates. The BAL fluid recovery rate was 56%, and the procedure was completed without subsequent complications. In addition, the percutaneous arterial oxygen saturation decreased to 95.7%±3.8%, although it was never lower than 90.0% during the procedure, and no patients required intubation. Furthermore, the arterial blood pressure significantly but transiently decreased due to sedation, and the procedure yielded diagnostic information in all nine patients. Conclusion FOB-BAL using LMA and CPAP appears to be safe and effective in patients who develop severe acute hypoxaemia.
目的 纤维支气管镜检查联合支气管肺泡灌洗术（FOB-BAL）是诊断和选择治疗弥漫性肺浸润急性低氧血症患者的重要工具。然而，FOB-BAL在操作过程中和操作后有发生严重低氧血症及随后气管插管的风险。使用喉罩气道（LMA）联合持续气道正压通气（CPAP）进行FOB-BAL可能会降低低氧血症的发生率；然而，该操作的安全性和有效性尚未得到研究。方法 对2013年4月至9月的数据进行回顾性图表审查。收集有关支气管肺泡灌洗（BAL）液回收量、FOB-BAL完成后8小时内气管插管发生率、呼吸和血流动力学参数以及治疗调整的数据进行评估。结果 对9例伴有弥漫性肺浸润的严重急性低氧血症患者进行了10次使用LMA和CPAP的FOB-BAL试验。BAL液回收率为56%，操作完成后无后续并发症。此外，经皮动脉血氧饱和度降至95.7%±3.8%，尽管在操作过程中从未低于90.0%，且无患者需要插管。此外，由于镇静作用动脉血压显著但短暂下降，该操作在所有9例患者中均获得了诊断信息。结论 对于发生严重急性低氧血症的患者，使用LMA和CPAP进行FOB-BAL似乎是安全有效的。
