Ricou B, Grandin S, Nicod L, Thorens J B, Suter P M
Division of Surgical Intensive Care, University Hospital of Geneva, Switzerland.
Thorax. 1995 Mar;50(3):290-3. doi: 10.1136/thx.50.3.290.
Bronchoalveolar lavage is considered a safe procedure. When performed in the mechanically ventilated patient, however, potentially harmful effects on respiratory and haemodynamic functions have been reported in which the size of the bronchoscope may play a part. Two different size bronchoscopes (adult and paediatric) were therefore investigated with regard to bronchoalveolar lavage yield and side effects.
Twenty mechanically ventilated patients underwent bronchoalveolar lavage with both adult and paediatric bronchoscopes in a randomised sequential manner.
In a total of 45 pairs of bronchoalveolar lavage procedures no difference was noted between adult and paediatric bronchoscopes with regard to total cell yield, differential cell count, and microbiological results. Peak intratracheal pressure increased with the adult bronchoscope only. Systemic arterial pressures increased more with the adult than with the paediatric bronchoscope. PaO2 decreased with the adult but not with the paediatric bronchoscope.
The paediatric bronchoscope offers a comparable bronchoalveolar lavage yield in mechanically ventilated patients to the adult bronchoscope, while the respiratory and haemodynamic side effects are significantly lower than with the adult size instrument.
支气管肺泡灌洗被认为是一种安全的操作。然而，在机械通气患者中进行该操作时，已有报道称其对呼吸和血流动力学功能存在潜在有害影响，其中支气管镜的尺寸可能起一定作用。因此，对两种不同尺寸的支气管镜（成人型和儿童型）在支气管肺泡灌洗的回收率及副作用方面进行了研究。
20例机械通气患者以随机顺序先后使用成人型和儿童型支气管镜进行支气管肺泡灌洗。
在总共45对支气管肺泡灌洗操作中，成人型和儿童型支气管镜在总细胞回收率、细胞分类计数及微生物学结果方面未发现差异。仅成人型支气管镜使气管内峰值压力升高。成人型支气管镜导致的全身动脉压升高幅度大于儿童型支气管镜。成人型支气管镜使动脉血氧分压降低，而儿童型支气管镜则未出现这种情况。
在机械通气患者中，儿童型支气管镜的支气管肺泡灌洗回收率与成人型支气管镜相当，但其呼吸和血流动力学副作用明显低于成人尺寸的器械。
