Steinberg K P, Mitchell D R, Maunder R J, Milberg J A, Whitcomb M E, Hudson L D
Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Seattle, Wa 98104.
Am Rev Respir Dis. 1993 Sep;148(3):556-61. doi: 10.1164/ajrccm/148.3.556.
Although shown to be safe in many other lung disorders, the safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) in critically ill patients with adult respiratory distress syndrome (ARDS) remains unproven. We conducted a prospective study to evaluate the safety of BAL in patients with ARDS. There were 438 patients with ARDS at our institution during the study period. Of these, 110 underwent FOB and BAL for either research or clinical purposes. Data were collected at baseline, at 5-min intervals during the procedure, and 1 h after the procedure. We did not detect any statistically or clinically significant changes in PaO2/FlO2, mean arterial pressure, heart rate, peak inspiratory pressure, or static thoracic compliance after the procedure. A small decrease in SaO2 occurred after BAL. Although this change was statistically significant, the magnitude was not of clinical importance. Five patients (4.5%) had transient arterial oxygen desaturation to < 90% during FOB and one patient (0.9%) experienced desaturation to < 80%. There were no prolonged episodes of severe hypoxemia. No serious bleeding occurred. One pneumothorax developed during the procedure. No deaths occurred that were related to the procedure. We conclude that FOB and BAL can be performed safely and are reasonably well-tolerated in patients with ARDS.
尽管纤维支气管镜检查（FOB）联合支气管肺泡灌洗（BAL）在许多其他肺部疾病中已被证明是安全的，但在患有成人呼吸窘迫综合征（ARDS）的重症患者中其安全性仍未得到证实。我们进行了一项前瞻性研究，以评估BAL在ARDS患者中的安全性。在研究期间，我们机构有438例ARDS患者。其中，110例因研究或临床目的接受了FOB和BAL。在基线、操作过程中每隔5分钟以及操作后1小时收集数据。我们未检测到操作后动脉血氧分压/吸入氧分数、平均动脉压、心率、吸气峰压或静态胸廓顺应性有任何统计学或临床显著变化。BAL后动脉血氧饱和度（SaO2）出现小幅下降。尽管这一变化具有统计学意义，但幅度不具有临床重要性。5例患者（4.5%）在FOB期间出现短暂动脉血氧饱和度降至<90%，1例患者（0.9%）血氧饱和度降至<80%。未出现严重低氧血症的长时间发作。未发生严重出血。操作过程中发生1例气胸。未发生与操作相关的死亡。我们得出结论，ARDS患者可以安全地进行FOB和BAL，并且耐受性较好。
