Papazian L, Colt H G, Scemama F, Martin C, Gouin F
Department of Anesthesia and Critical Care, Sainte Marguerite Hospital, Marseilles, France.
Chest. 1993 Nov;104(5):1548-52. doi: 10.1378/chest.104.5.1548.
To assess cardiovascular effects and the oxygenation status of mechanically ventilated patients undergoing protected specimen brushing (PSB) and bronchoalveolar lavage (BAL) under fiberoptic bronchoscopy (FOB).
A prospective study.
Polyvalent intensive care unit in a university hospital.
Twelve consecutive, critically ill, intubated, and mechanically ventilated patients with hemodynamic failure requiring invasive monitoring with an indwelling radial artery catheter and indwelling Swan-Ganz catheter were included in the study.
Hemodynamic measurements, arterial and mixed-venous blood gas analyses, and arterial blood lactate analysis were performed before and at the end of a 10-min period of mechanical ventilation with a fractional concentration of oxygen in the inspired gas (FIO2) of 1.0. The same measurements and blood samplings were repeated at the end of the PSB procedure, at the end of the BAL procedure, and 1 h after the end of the BAL. During the study period the ECG, arterial oxygen saturation (SaO2), and mixed-venous oxygen saturation (SvO2) were continuously monitored.
A moderate increase in both mean arterial pressure and mean pulmonary arterial pressure was observed during the FOB procedure (p < 0.05). One hour after the end of BAL, the PaO2 decreased when compared with values recorded at the beginning of the procedure with the same FIO2 (p < 0.05). An increase in intrapulmonary shunt was observed at the end of BAL (p < 0.01). A moderate increase in PaCO2 was also observed after PSB (p < 0.05) and after BAL (p < 0.01). Monitoring of SaO2 permitted us to observe a significant and sustained decrease after the end of the FOB procedure from 10 to 60 min. The decrease in SvO2 was less pronounced but reached statistical significance.
We conclude that PSB and BAL under FOB are well tolerated in critically ill, mechanically ventilated patients with hemodynamic disturbances requiring inotropic or vasopressor agents (or both); however, a modest impairment in arterial oxygenation was observed after the end of the FOB procedure.
评估在纤维支气管镜检查（FOB）下接受保护性标本刷检（PSB）和支气管肺泡灌洗（BAL）的机械通气患者的心血管效应和氧合状态。
一项前瞻性研究。
一所大学医院的多科重症监护病房。
连续12例患有血流动力学衰竭、需要通过留置桡动脉导管和留置Swan-Ganz导管进行有创监测的重症、插管且机械通气的患者被纳入研究。
在吸入气中氧分数（FIO2）为1.0的10分钟机械通气之前和结束时，进行血流动力学测量、动脉和混合静脉血气分析以及动脉血乳酸分析。在PSB操作结束时、BAL操作结束时以及BAL结束后1小时重复相同的测量和血液采样。在研究期间，持续监测心电图、动脉血氧饱和度（SaO2）和混合静脉血氧饱和度（SvO2）。
在FOB操作期间观察到平均动脉压和平均肺动脉压均有适度升高（p < 0.05）。BAL结束后1小时，与在相同FIO2下操作开始时记录的值相比，动脉血氧分压（PaO2）降低（p < 0.05）。在BAL结束时观察到肺内分流增加（p < 0.01）。在PSB后（p < 0.05）和BAL后（p < 0.01）也观察到动脉血二氧化碳分压（PaCO2）有适度升高。对SaO2的监测使我们观察到在FOB操作结束后10至60分钟出现显著且持续的下降。SvO2的下降不太明显，但达到统计学显著性。
我们得出结论，对于患有血流动力学紊乱、需要使用正性肌力药物或血管升压药物（或两者）的重症、机械通气患者，FOB下的PSB和BAL耐受性良好；然而，在FOB操作结束后观察到动脉氧合有适度损害。
