Intensive Care Medicine

, Volume 24, Issue 12, pp 1289–1293

Changes in pulmonary mechanics after fiberoptic bronchoalveolar lavage in mechanically ventilated patients

  • U. Klein
  • W. Karzai
  • P. Zimmermann
  • U. Hannemann
  • U. Koschel
  • J. X. Brunner
  • H. Remde
ORIGINAL

DOI: 10.1007/s001340050764

Cite this article as:
Klein, U., Karzai, W., Zimmermann, P. et al. Intensive Care Med (1998) 24: 1289. doi:10.1007/s001340050764

Abstract

Objective: We prospectively assessed the impact of bronchoalveolar lavage (BAL) on respiratory mechanics in critically ill, mechanically ventilated patients. Study design: Mechanically ventilated patients underwent BAL of one lung segment using 5 × 20 ml of sterile, physiologic saline with a temperature of 25–28 °C. The fractional inspired oxygen was increased to 1.0, but ventilator settings were otherwise left unchanged. Static pulmonary compliance, pulmonary resistance, alveolar ventilation, and serial dead space were measured 60 min and 2 min before and 8, 60, and 180 min after BAL to assess the consequences of the procedure. In addition, blood gases [partial pressure of carbon dioxide in arterial blood (PaCO2) and arterial oxigen tension (PaO2)], hemodynamic variables (heart rate, systolic and diastolic blood pressure), and body temperature were recorded at the same time points. Setting: Intensive care unit of a university hospital. Patients: 18 consecutive critically ill, mechanically ventilated patients. Results: Pulmonary compliance decreased by 23 % (p < 0.05) and pulmonary resistance increased by 22 % (p < 0.05) shortly after BAL. The changes in pulmonary compliance and resistance were more than 30 % in one third of the patient population. One hour after the procedure, PaO2 was significantly lower and PaCO2 significantly higher than before the procedure. Three hours after the procedure, pulmonary resistance returned to pre-BAL values but compliance remained 10 % below baseline values (p < 0.05). Conclusion: BAL in mechanically ventilated patients is associated with deterioration of pulmonary mechanics and function.

Key words BAL Bronchoalveolar lavage Pulmonary mechanics Pulmonary compliance Pulmonary resistance Mechanical ventilation Respiratory function Intensive care 

Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • U. Klein
    • 1
  • W. Karzai
    • 1
  • P. Zimmermann
    • 1
  • U. Hannemann
    • 1
  • U. Koschel
    • 1
  • J. X. Brunner
    • 2
  • H. Remde
    • 1
  1. 1.Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University Jena, Bachstr. 18, D-07 740 Jena, Germany Tel. + 49(3641)933831; Fax + 49(3641)933256DE
  2. 2.Hamilton Bonaduz AG, SwitzerlandCH

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