Effect Of Bronchoalveolar Lavage On The Patients Accepted Mechanical Ventilation Caused By Drowning

BackgroundIn recent years, drowning morbidity increases with the development of economy and increased accident rate. More acute lung injury/acute respiratory distress syndrome and critical pulmonary infection happen to drowning patients, and they need invasive mechanical ventilation therapy. However, remedy difficulty of severe drowning patients is big and remedy time is long, and there aren’t clear and effective remedy standard. More effective therapeutic methods need be discussed.Sewage and foreign body aspirated into lungs by drowning patients contains a large number of bacteria, plankton and pungent toxic substance, which result in acute lung injury/acute respiratory distress syndrome and serious pulmonary infection as primary causes. At present common therapeutic measures are as follows:First, invasive mechanical ventilation is usually given to acute lung injury/acute respiratory distress syndrome patients. Respiratory rate of them is faster, which result in bad man-machine harmony and it influences curative effect of mechanical ventilation. Tranquilizing drugs are usually used to reduce respiratory rate and improve man-machine harmony. However they also restrain patients’cough, which makes sewage and foreign body aspirated into lungs difficult to cough up. Foreign body and airway secretions lead to pulmonary atelectasis or pulmonary consolidation, which gives rise to augment of airway resistance, decline of effective alveolar ventilation and oxygenation index. In cycles,this forms vicious cycle. Therefor, most fundamental improving measures are to seek a method which can thoroughly clean foreign body and airway secretions.Second,as to pulmonary infection, anti-infective therapy is strengthened, and keeling over and taking back, expectoration by vibrating and postural drainage and so on are supplemented. However, severe drowning patients have acute lung injury/acute respiratory distress syndrome, rapid respiratory rate, weak cough and autonomous respiration and cough reflex suppression resulted by calm treatment,which make foreign body aspirated into lungs and intrapulmonary airway secretions difficult to clean by cough reflex, and they turn into intrapulmonary sources of infection uncontrollable and severe only by putting antibiotics into use. Ultimately, this may leads to septic shock and multiple organ failure.Therefore, clearing lower respiratory tract is a significant meaning of treating acute lung injury/acute respiratory distress syndrome and pulmonary infection, only by the way of autonomously coughing and expectorating, the efficiency is tardy,the time of controlling acute lung injury/acute respiratory distress syndrome and pulmonary infection is longer, even uncontrollable.Clinical practice finds that by means of normal saline flushing trachea and bronchus at all levels, bronchoalveolar lavage can more rapidly suck out sewage, foreign body and secretion difficult to expectorate, clear lower respiratory tract and lower the content of intrapulmonary bacteria and corrosive substance to quickly and thoroughly clean source of infection and precipitating factors of acute respiratory distress syndrome and cut off reaction chain of multiple organ failure.In addition, bronchoalveolar lavage can directly wash and draw little sputum bolt formed by secretion at paragraphs bronchial tube mouth,take out the bigger endobronchial foreign body difficult to expectorate by fiberoptic bronchoscopy biopsy forceps, so that focal pulmonary atelectasis resulted by little sputum bolt and foreign body is improved, together with pulmonary ventilation function and oxygenation.The above is benefical to recovery of respiratory function.At present, bronchoalveolar lavage is more and more used to lower respiratory tract infection diseases such as severe pneumonia and aspiration pneumonia and so on, which achieves obvious curative effect. Meanwhile, it can shorten hospital time and reduce medical cost. In recent years, we apply bronchoalveolar lavage to severe drowning patients receiving invasive mechanical ventilation and achieve good curative effect. However, at the moment there isn’t scientific evaluation that bronchoalveolar lavage is used to treat severe drowning patients.Objective1. Further confirm therapeutic effect of Bronchoalveolar Lavage on the patients with respiratory failure by drowning and oral trachea cannula mechanical ventilation and its clinical application value.2. Investigate operating skills of Bronchoalveolar Lavage when invasive mechanical ventilation going.Subjects and MethodsResearch objects derive from respiratory failure patients who adopt invasive mechanical ventilation by drowning in Binzhou People’s Hospital from March2000to June2012.73research objects are selected:experimental group for33treated by Bronchoalveolar Lavage,while control group for40not treated by Bronchoalveolar Lavage, obtained by looking up previous medical records.Collect smoking history and COPD history, indexes of invasive mechanical ventilation of research objects admitted to hospital at beginning and48hours after, including breathing mechanics indicators:Ppeak, tidal volume angso on, anapnea physiology indicators:oxygenation index, carbon dioxide partial pressure, respiratory frequency andso on, and clinical indicators:temperature,fever time, ICU time and mechanical ventilation time and so on.Once received by ICU,73drowning patients immediately treated by oral trachea cannula mechanical ventilation. Suppose prior-treatment for beginning and posttreatment for48hours after hospital,and compare indictors between prior-treatment and posttreatment for experimental group,control group or experimental group and control group. Regulate possible confounding factors by generalized linear regression and explore influencing factors of numerical variable indictors. ResultsCompared with experimental group,5patients died in control group, and other patients take a turn for the better. There is statistical significance about rise of oxygenation index, pH and decline of an apnea physiology, breathing mechanics and clinical indicators such as respiratory frequency, temperature, P-peak, positive end-expiratory pressure, carbon dioxide partial pressure and so on, between prior-treatment and post-treatment of experimental group. There isn’t statistical significance about variations of oxygenation index, pH, respiratory frequency, temperature, P-peak, positive end-expiratory pressure, carbon dioxide partial pressure between prior-treatment and post-treatment of control group(35case which take a turn for the better). After adjusting the influence of the above three imbalanced indexes by linear-regression analysis, we post-treatment indexes of experimental group with control group:oxygenation index of experimental group is54.22higher than one of control group, PH of experimental group is0.03higher than one of control group, tidal volume of experimental group is99.38ml higher than one of control group, respiratory frequency of experimental group is8.13bpm lower than one of control group, temperature of experimental group is0.57℃lower than one of control group, P-peak of experimental group is4.87mmHg lower than one of control group, positive end-expiratory pressure of experimental group is2.71mmHg lower than one of control group, carbon dioxide partial pressure of experimental group is6.26mmHg lower than one of control group, fever time of experimental group is3.52days less than one of control group, ICU hospital time of experimental group is2.60days less than one of control group, and mechanical ventilation time of experimental group is1.35days less than one of control group. There is statistical significance about diversity of above-mentioned indictors (P<0.05)ConclusionsBronchoalveolar lavage is beneficial to oral trachea cannula mechanical ventilation drowning patients about improvement of temporary physiological and clinical indexes and long-term control of pulmonary infection. Meanwhile, it can reduce ICU hospital time and lower remedy cost.