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Pak J Med Sci March - April 2020 Vol. 36 No. 3 www.pjms.org.pk 396Correspondence:Yuqin Zhao,Emergency Intensive Care Unit,Binzhou People’s Hospital,No. 515, Huanghe 7th Road,Shandong 256610, China.E-mail: yuqinzhaoio@163.com * Received for Publication: August 21, 2019 * Revision Received: November 25, 2019 * Revision Accepted: December 15, 2019INTRODUCTIONPulmonary infection is a pulmonary parenchymal inflammation that occurs in the pulmonary interstitial, alveolar cavity and terminal airway. It is mainly caused by infection, especially bacteria with strong toxicity, drug-resistance bacteria or several kinds of bacteria, and Staphylococcus aureus and streptococcus pneumoniae are common pathogenic bacteria; the clinical manifestations of Original ArticleBronchial lavage under fiberoptic bronchoscopy in the treatment of severe pulmonary infectionYuqin Zhao1, Xuemei Dai2, Jinzhi Ji3, Ping Cheng4ABSTRACTObjective: To investigate the clinical efficacy of bronchial lavage under fiberoptic bronchoscopy in the treatment of severe pulmonary infection.Methods: One hundred forty eight patients with severe pulmonary infection who were admitted to our hospital from October 2016 to December 2017 were included in this study. According to the random number table method, they were divided into a control group and an observation group with 79 patients each. The control group was given conventional treatment, while the observation group was given bronchoalveolar lavage with fiberoptic bronchoscopy on the basis of the treatment in the control group. The clinical efficacy of the two groups was compared, the duration of mechanical ventilation, antibiotic use and symptoms improvement of the two groups were recorded, and the respiratory mechanics parameters, serum procalcitonin (PCT) and transforming growth factor β (TGF-β) level were measured before and after treatment.Results: The duration of mechanical ventilation, antibiotic use, respiratory failure correction, body temperature decline and white blood cell recovery in the observation group were significantly shorter than those in the control group (P<0.05). The total efficacy of the observation group was significantly higher than that of the control group (92.4% vs. 74.7%). The respiratory mechanics parameters of the two groups after treatment were higher than those before treatment (P<0.05) and the increase of the observation group was more obvious than that of the control group (P<0.05). The serum PCT and TGF-β levels of the two groups after treatment were lower than those before treatment (P<0.05), and the decrease level in the observation group was more obvious (P<0.05).Conclusion: Bronchial lavage under fiberoptic bronchoscopy can improve the clinical efficacy, accelerate the improvement of clinical symptoms and respiratory mechanics parameters, significantly reduce the PCT and TGF-β levels, and promote the rapid recovery of patients in the treatment of severe pulmonary infection.KEYWORDS: Bronchial lavage, Fiberoptic bronchoscopy, Severe pulmonary infection.doi: https://doi.org/10.12669/pjms.36.3.1539How to cite this:Zhao Y, Dai X, Ji J, Cheng P. Bronchial lavage under fiberoptic bronchoscopy in the treatment of severe pulmonary infection. Pak J Med Sci. 2020;36(3):396-401. doi: https://doi.org/10.12669/pjms.36.3.1539This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Yuqin Zhao et al.Pak J Med Sci March - April 2020 Vol. 36 No. 3 www.pjms.org.pk 397pulmonary infection are mainly cough, increased airway secretion and weakness.1,2 Severe pulmonary infection is a critical disease with varying degrees of abnormal respiratory mechanics parameters, and it stimulates the over expression of multiple inflammatory factors, among which the overexpression of procalcitonin (PCT) and transforming growth factor β (TGF-β) is more obvious; therefore, the disease can be assessed by the measurement of the two growth factors levels.3,4 If severe pulmonary infection is in a serious condition, delayed treatment may even lead acute respiratory failure, which will seriously threaten the patient’s life safety and physical health.5Active control of infected lesions is the key to the treatment. Currently in the simple systemic anti-infective treatment of lesions, effective drug concentration to topical lesion is low, and the wide application of broad-spectrum antibacterial drugs in the treatment increases drug-resistant strains, which makes it difficult to effectively control infections and leads to bad efficacy.6 Therefore, the key to the treatment of severe pulmonary infections is to keep the patient’s breathing smooth so that the drug can work effectively. A study has shown that lung secretions could cause airway obstruction,7increase the difficulty of sputum excretion, cause accumulation of stimulating substances, and lead to a series of cascade reactions. As a precise examination instrument, fiberoptic bronchoscope is often used in the diagnosis and treatment of various bronchial diseases, and it can remove sputum and inflammatory secretions in the visible conditions, and fully wash the lesions of patients with pulmonary infection to better control of the condition.8,9 This study aims to analyze the efficacy of bronchoalveolar lavage under fiberoptic bronchoscopy in the treatment of severe pulmonary infection and provide a reference for clinical practices. METHODSA total of 148 patients with severe pulmonary infection who were admitted to our hospital from October 2016 to December 2017 were randomly divided into an observation group and a control group. Inclusion criteria included being confirmed with severe pulmonary infection by laboratory and imaging examinations, without serious organ diseases and coagulopathy, and be able to tolerate bronchoscopy and treatment. Exclusion criteria included unconscious with mental disorders,pregnant and lactating women and with extremely poor compliance. There were 49 males and 30 females in the observation group, whose ages varied from 37 to 74 (52.6±5.2) years old; as to lung infection pathogens, there were 16 cases of Gram-positive bacteria, 53 cases of Gram-negative bacteria, and 10 cases of fungi; as to basic diseases, there were 27 cases of diabetes, 22 cases of chronic obstructive pulmonary disease, 14 cases of stroke, 11 cases of acute lung abscess, and 5 cases of other diseases. There were 46 males and 33 females in the control group, whose ages varied from 38 to 75 (52.4±5.3) years old; as to lung infection pathogens, there were 19 cases of Gram-positive bacteria, 49 cases of Gram-negative bacteria and 11 cases of fungi; as to basic diseases, there were 30 cases of diabetes, 19 cases of chronic obstructive pulmonary disease, 16 cases of stroke, eight cases of acute lung abscess, and 6 cases of other diseases. There was no significant difference in the general data such as age, sex, distribution of pathogens and basic diseases between the two groups (P>0.05); therefore, the results could be compared. The study was reviewed and approved by the ethics committee of the hospital (No. 115 dated December 19, 2018), and all patients or their families signed informed consent.Treatment methods: Patients in the control group underwent routine treatment, including anti-infective therapy, mechanical ventilation and symptomatic treatment. Patients in the observation group were treated with bronchoalveolar lavage with fiberoptic bronchoscopy on the basis of the treatment in the control group. The specific procedure was as follows. Subcutaneous atropine injection was given to the patients 15 minutes before surgery. If patients were over-stressed, they could be injected with 10mg of diazepam half an hour before surgery. Then patients were anesthetized by lidocaine aerosol inhalation, fiberoptic bronchoscopy was sent to their tracheas, and some sputum was aspirated. Bacteria in sputum was cultivated, and then the front end of the fiberoptic bronchoscope was sent to the bronchial opening of the lung segment for lavage. Subsequently, the specific catheter of the fiberoptic bronchoscope was sent to the biopsy hole for sub-stage lavage. The lavage fluid was sterile saline, and the temperature was controlled at 37°C. The volume of lavage fluid was 10-15 ml each time, the total volume was within 200 ml, and the lavage in each lung segment was controlled as 2 or 3 times. Vacuum suction was performed after the end of lavage, and the pressure was controlled at 7 to 10
Yuqin Zhao, Xuemei Dai, Jinzhi Ji, Ping Cheng. (2020) Bronchial lavage under fiberoptic bronchoscopy in the treatment of severe pulmonary infection, Pakistan Journal of Medical Sciences, Volume -36, Issue 3.
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