A simple method of reducing complications of pediatric nonbronchoscopic bronchoalveolar lavage.

Abstract:

:Our objective was to determine whether a simple method of maintaining positive pressure ventilation during nonbronchoscopic bronchoalveolar lavage (NB-BAL) would successfully reduce the incidence and/or severity of desaturation events. Our design was a clinical trial with historical controls. Seventy ventilated pediatric patients undergoing diagnostic NB-BAL participated. Two NB-BAL techniques were compared: 1) the "unsealed" method, where the suction catheter was passed through an open system, maintaining oxygenation but not airway pressure; and 2) the "sealed" technique, which was identical except that the catheter was passed through a diaphragm, maintaining positive pressure ventilation throughout. NB-BAL was performed on 35 patients using the "unsealed" technique and 2 years later on 35 patients using the "sealed" method. Heart rate and oxyhemoglobin saturation (SaO(2)) were recorded before, during, and after NB-BAL. There was no difference between groups with regard to demographic data, oxygenation, or ventilatory requirements (P >or= 0.1). The "sealed" group experienced a median drop in SaO(2) of 6.0% (range, -6% to 44%), and the "unsealed" group a drop of 13.0% (-2% to 61%), during NB-BAL (P < 0.05). Patients with oxygenation index greater than 10 experienced the most severe desaturation events in both groups: 53.8% of patients in the "sealed" group with oxygenation index >10 desaturated to <80% vs. 91.6% in the "unsealed" group (P < 0.05). In conclusion, we describe a simple, inexpensive modification of the NB-BAL technique that reduces the incidence and severity of desaturation during NB-BAL.

journal_name

Pediatr Pulmonol

journal_title

Pediatric pulmonology

authors

Morrow B,Futter M,Argent A

doi

10.1002/ppul.20082

subject

Has Abstract

pub_date

2004-09-01 00:00:00

pages

217-21

issue

3

eissn

8755-6863

issn

1099-0496

journal_volume

38

pub_type

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