Short-Term Efficacy Of Prone Ventilation Combined With Bronchoalveolar Lavage On Severe Pneumonia With Mechanical Ventilation

Objectives:Study prone position(PP),Bronchoalveolar.lavage;BAL)and combined treatment of Severe pneumonia SP on mechanical ventilation.Methods:A prospective experimental controlled study was conducted.96 patients with severe pneumonia on mechanical ventilation who met the inclusion criteria were admitted to the emergency ICU of the Affiliated Hospital of North Sichuan Medical College and the intensive care department of the three affiliated Hospitals of North Sichuan Medical College from June 20,2020.to January 20,2022.01.Random number table method was used to divide them into combined group(prone position ventilation combined bronchoalveolar lavage group(n=24)),prone position ventilation group(n=24),bronchoalveolar lavage group(n=24)and blank control group(no prone position ventilation combined bronchoalveolar lavage group(n=24)).Collect general clinical data from patients,Acute physiological and chronic health assessment(APACHE)was performed in four groups before treatment(TO)and 3 and 7 days after treatment(T3 and T7)Ⅱ)Score,simplified CPIS score,inflammatory indicators(PCT,C-reactive protein,neutrophil%),oxygenation index,cardiac function indicators(CO,CI,SV,SVV,TFC),lactic acid level,length of stay in ICU and other indicators.All data were statistically analyzed using SPSS26.0.The measurement data conforming to normal distribution were represented by mean ± standard deviation(x±S)and repeated measure anOVA was performed.The measurement data conforming to normal distribution were represented by median(quad)(M(QL,QU))and analyzed by generalized estimation equation.Count data were expressed by(%),and comparison between groups was performed by X2 test.P<0.05 indicates statistical significance.Results:(1)General data:A total of 96 eligible patients with severe pneumonia were collected in this study,including 71 males and 25 females.There was no statistical significance in age,gender composition,APACHEII score within 24 hours and SIMPLE CPIS score among the four groups at the time of enrollment(P>0.05).(2)Influence of combination therapy of prone ventilation and bronchoalveolar lavage on critical disease score of severe pneumonia patients:①APACHE ⅱ score:compared with the prone ventilation group and the alveolar lavage group,the combined group had statistical significance at T7 time(P<0.05),but no statistical significance at T3 time(P>0.05).There was no statistical significance between the prone ventilation group and the bronchoalveolar lavage group(P>0.05).② Simple CPIS score:compared with the prone ventilation group and alveolar lavage group,the combined group had statistical significance at T3 and T7(P<0.05),but there was no statistical significance between the prone ventilation group and bronchoalveolar lavage group(P>0.05).(3)Effects of combined therapy of prone ventilation and bronchoalveolar lavage on oxygenation index of severe pneumonia patients:Compared with the prone ventilation group,bronchoalveolar lavage group and blank control group,the difference between the combined group was statistically significant(P<0.05),the difference between the prone ventilation group and bronchoalveolar lavage group was statistically significant(P<0.05),and the difference between the prone ventilation group and bronchoalveolar lavage group was not statistically significant(P>0.05).(4)Effects of combination therapy of prone ventilation and bronchoalveolar lavage on inflammatory indexes(PCT,CRP and N%)of severe pneumonia patients:The percentage of C-reactive protein and neutrophil in bronchoalveolar lavage group and combined group was significantly different from that in prone ventilation group and blank control group(P<0.05),while there was no significant difference between the combined group and bronchoalveolar lavage group(P>0.05).There was no statistical significance between prone ventilation group and blank control group(P>0.05).As an inflammatory indicator,PCT showed no significant difference at the same time point among the four groups(P>0.05).(5)Effects of combined therapy of prone ventilation and bronchoalveolar lavage on cardiac function indexes(CO,CI,SV,SVV,TFC)and lactate level in patients with severe pneumonia:Four groups of 3 and 7 days after treatment in patients with CO,CI,SV,SVV index has no obvious change,there was no statistically significant difference(P>0.05),no significant difference between Lac indicators in four groups,no statistically significant difference(P>0.05),and pleural fluid content in the prone position ventilation group,combined the bronchoalveolar lavage group and blank control group,The difference was statistically significant(P<0.05),there was no statistical significance between the prone ventilation group and the combined group(P>0.05),and there was no statistical significance between the bronchoalveolar lavage group and the blank control group(P>0.05).(6)The effect of combined therapy of prone ventilation and bronchoalveolar lavage on ICU stay time of patients with severe pneumonia:the ICU stay time in the combined group was the shortest,and the ICU stay time in the blank control group was the longest,with statistically significant difference(P<0.05).Conclusion:1.Prone position ventilation,bronchoalveolar lavage alone or the combination of the two can improve the severity of mechanical ventilation patients with severe pneumonia,reduce APACHEII and simple CPIS scores,and improve oxygenation index,among which the combined group has the better effect.2.Bronchoalveolar lavage was superior to prone ventilation in reducing body inflammation,while prone ventilation was superior to bronchoalveolar lavage in reducing body fluid content.3.Prone ventilation,bronchoalveolar lavage alone or in combination can shorten the ICU stay time,and the ICU stay time in the combined group is the shortest.4.Prone ventilation,bronchoalveolar lavage alone or in combination had no significant effect on cardiac function indexes.