| ObjectiveTo investigate the effect of bronchoalveolar lavage (BAL) to chronic obstructivepulmonary disease (COPD) with acute exacerbation and severe respiratory failurereceiving invasive-noninvasive sequential ventilation therapy regarding pulmonaryinfection window time, mechanical ventilation time, ventilator associatedpneumonia(VAP),the rate of reintubation and the prognosis.Methods61AECOPD patients with tsevere respiratory failure primary tobronchial-pulmonary infection were divided into two groups randomly. There were32and29patients in therapeutic group and control group respectively. PIC windowwas used as the switch point to administer invasive-noninvasive sequential ventilationtherapy in both groups, while bronchoalveolar lavage was also applied in therapeuticgroup. After the appearance of pulmonary infection control window, all were treatedwith extubation and noninvasive positive pressure ventilation, after that theventilation parameters were down regulated until the liberation from the noninvasiveventilation,then take oxygen with wenturi mask,during this period,if the patient’s condition deteriorated to reach the standard of intubation,patients were reintubatedand received invasive mechanical ventilation therapy,the endpoint of observationwas transferring out of ICU or hospital death, the main indicators included:pulmonary infection window time(the time when invasive switched to noninvasive),total mechanical ventilation time, incidence of VAP,the rate of reintubation within48hours after extubation,detection rate of pathogen and the mortality in hospital.Results1.PIC window of the control group(the time when invasive switched tononinvasive)came in (6.2±1.8) day, while it came (3.8±1.0) day in treatmentgroup. Compared with the control group, PIC window of the treatment groupappeared significantly in advance, the time of invasive mechanical ventilation wassignificantly shorted (P <0.01).2..The whole time of mechanical ventilation about control group was (15.5±5.2)d, while the treatment group was (12.6±5.3)d. Compared with control group,treatment group total mechanical ventilation time was significantly shortened (P <0.05).3.The incidence of VAP in control group was20.69%while the treatment groupwas9.38%. Compared with control group, the incidence of VAP in treatment groupwas significantly lower (P <0.05).4.The control group etiology detection rate was41.38%and the treatment groupwas78.13%. Compared with control group, the treatment group etiology detectionrate was significantly higher (P <0.01).5. The rate of intubation about control group48hours after extubation was13.793%,while the treatment group was3.125%.Compared with control group, Theintubation rate of treatment group48hours after extubation was lower(P <0.05).6.The control group hospital mortality was13.793%while the treatment grouphospital mortality was3.125%. Compared with control group, treatment groupmortality was lower.(P <0.05).7.The treatment group used bronchoalveolar lavage beside the bed therapy for 118times.All of the patients were transient arrhythmia, hypoxia,6cases ofpostoperative fever, mild bronchospasm in2cases, bronchial mucosa bleeding in2cases.Conclusion1.Bronchoalveolar lavage joint with invasive-noninvasive sequential mechanicalventilation therapy for bronchial-pulmonary infection patients with AECOPD andrespiratory failure can make PIC window appear in advance, shorten the time of theinvasive ventilation, reduce the incidence of VAP, improve the detection rate ofpathogeny, reduce the rate of reintubation within48hours after extubation,so as toimprove the prognosis.2.The complications such as transient arrhythmia, hypoxia, bronchospasm,bronchial mucosa bleeding, and postoperative fever etc were happened duringBronchoalveolar lavage. Mostly of them could alleviate or recover when stop theoperation,give simple processing or even no treatment, no serious complications willoccur. The bronchial lavage treatment was relative safty. |
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