早期支气管镜检查在机械通气的误吸性肺炎患者中的应用
Use of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonitis.
作者信息
Megahed Mohammed M, El-Menshawy Ahmed M, Ibrahim Ahmed M
机构信息
Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
出版信息
Indian J Crit Care Med. 2021 Feb;25(2):146-152. doi: 10.5005/jp-journals-10071-23718.
BACKGROUND AND OBJECTIVES
Aspiration-induced lung injury accounts for a significant proportion of acute pulmonary dysfunction. Few studies were conducted to study the use of early bronchoscopy in mechanically ventilated patients with aspiration pneumonitis. This study aimed at assessing the clinical impact of early bronchoscopy for removal of gastric fluid and solid particles in the first 24 hours of mechanical ventilation (MV) on the progression of aspiration, MV days, intensive care unit (ICU) stay, development of pneumonia, and ICU mortality.
MATERIALS AND METHODS
The study was an open-label randomized control trial and included 76 adult subjects mechanically ventilated due to aspiration pneumonitis, half the subjects received early bronchoscopy in the first 24 hours after aspiration for removal of aspirated material and bronchoalveolar lavage sampling, the other half received standard treatment.
RESULTS
The intervention group had a significant reduction in the rate of development of pneumonia at 60.5 vs 81.6%, = 0.043 through the first week of admission, the intervention group has a significantly better hypoxic index (HI), white blood count, clinical pulmonary infection score, lung injury score, and sepsis-related organ failure assessment (SOFA) score compared to the control group. Although there was a reduction in mechanical ventilation days and ICU mortality in the intervention group vs control group that difference did not reach statistical significance.
CONCLUSIONS
Early bronchoscopy in mechanically ventilated patients with aspiration pneumonitis can be beneficial in improving respiratory functions and decreasing the incidence of development of aspiration pneumonia and may guide the de-escalation of antibiotic therapy.
HOW TO CITE THIS ARTICLE
Megahed MM, El-Menshawy AM, Ibrahim AM. Use of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonitis. Indian J Crit Care Med 2021;25(2):146-152.
背景与目的
误吸所致肺损伤在急性肺功能障碍中占相当大的比例。针对机械通气的误吸性肺炎患者早期支气管镜检查的应用，开展的研究较少。本研究旨在评估在机械通气（MV）的最初24小时内进行早期支气管镜检查以清除胃液和固体颗粒，对误吸进展、MV天数、重症监护病房（ICU）住院时间、肺炎发生情况及ICU死亡率的临床影响。
材料与方法
本研究为开放标签随机对照试验，纳入76例因误吸性肺炎接受机械通气的成年受试者，一半受试者在误吸后的最初24小时内接受早期支气管镜检查以清除误吸物质并进行支气管肺泡灌洗采样，另一半接受标准治疗。
结果
干预组在入院第一周内肺炎发生率显著降低，为60.5%，而对照组为81.6%，P = 0.043。与对照组相比，干预组的低氧指数（HI）、白细胞计数、临床肺部感染评分、肺损伤评分及脓毒症相关器官功能衰竭评估（SOFA）评分均显著更好。尽管干预组与对照组相比机械通气天数和ICU死亡率有所降低，但差异未达到统计学意义。
结论
对于机械通气的误吸性肺炎患者，早期支气管镜检查有助于改善呼吸功能，降低误吸性肺炎的发生率，并可能指导抗生素治疗的降阶梯。
如何引用本文
Megahed MM, El-Menshawy AM, Ibrahim AM. 机械通气的误吸性肺炎患者早期支气管镜检查的应用。《印度重症监护医学杂志》2021；25(2):146 - 152。
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