Clinical Comparison Between Protected Bronchoalveolar Lavage And Sterility Sputum Aspirating Tube On Mechanical Ventilated Patients With Severe Pneumonitis

Objective: In recent years, with the rapid development of severe respiratory care and mechanical ventilation technology, Multidisciplinary intensive care units are established. Especially in respiratory intensive care unit, Mechanical ventilation is a method of respiratory support for patients with severe respiratory failure,which is not an etiological treatment, Therefore it can not cure disease. Mechanical ventilation strive time of treatment and create conditions for the various causes of respiratory failure. The so-called “buy time” function. Therefore in the process of rescuing critical patients,to clear the purpose of mechanical ventilation is necessary. Patients with severe pneumonia is the leading cause of increaseing mortality and difficult weaning in patients,Therefore early bacterial culture was conducted to obtain correct etiological diagnosis, rational use of sensitive antibiotics is the key to improve the success rate of rescue. Secretion and lung tissue is collected by percutaneous lung puncture biopsy and open lung biopsy, can be used for histologic examination and special pathogen examination and culture, the diagnosis rate is very high, that is the gold standard for the diagnosis of pneumonia. But because lung biopsy is invasive examination, and complications is relatively more and can not be early diagnosis, therefore, in clinical practice it is difficult to generally carry out. Sterile sputum suction tube is widely used in clinical, which is easily affected by external pollution in taking etiology from lower respiratory. Bronchoalveolar lavage is a methord of examination the cells constituents, soluble constituents and bronchial secretions,which through pouring physiological saline into local bronchovesicular by fiber bronchoscope, then aspirate surface to obtain alveolar lining fluid. It is the best method to clear possible etiology for severe pneumonia at an early date. Because in the appropriate parts materials can improve the rate of separation of pathogenic microorganisms, The results of the accuracy and credibility increase, the sensitivity is 70-90%, the specificity is up to 80-100%. Balthazar performed in 37 patients with bronchial alveolar lavage for quantitative bacterial culture,the sensitivity was 90%, specificity was up to 94.1%. However, BAL has a most prominent question in the diagnosis of bacterial infection is affected by the upper respiratory tract resident bacteria contamination. So we want to distinguish by quantitative culture of lavage fluid contaminated with pathogenic bacteria. Meduri reported that a protected bronchoalveolar lavage technique can effectively prevent upper respiratory tract flora pollution in 1991. In recent 10 years, With the deepening of the research and application of PBAL, On the value of PBAL has a new evaluation, In the first, the sampling range of PBAL is bigger than protected specimen brush, also may be involving the relating lung parenchyma、good sensitivity and sampling, Secondly, Sampling volume can provide a variety of inspection, Therefore, at present, PBL has been widely used in diffuse lung disease, especially the etiological diagnosis of mechanical ventilation pulmonary infiltration. Quantitative culture with PBAL is more than or equal to 104cfu/ml as a positive diagnosis standard, has a high sensitivity and specificity. In this study, through the clinical comparison between protected bronchoalveolar lavage and sterility sputum aspirating tube on mechanical ventilated patients with severe pneumonitis,then to discuss what kind of method get the etiology more accurate,thus to provide timely and effective guidance to the clinical diagnosis and treatment.Methods:Mechanically ventilated patients with intensive care unit pneumonitis from January of 2014 to January of 2015 which are choosed from the third department of respiration in the first hospital of Shijiazhuang have a total of 60 cases. All sixty patients with protected bronchoalveolar lavage and sterility sputum aspirating tube two methods of sampling,and the analysis of the etiology and diagnostic test evaluation.Among them,there are 47 male cases and 13 female cases. The age range from 36 to 90 years old, average 63 years old. Both for the purposes of tracheal intubation or incision of trachea intubation patients. The main underlying disease is severe pneumonia. Diagnostic standard consults the standard diagnosis of severe pneumonia of respiratory diseases of Chinese Medical Association. The main standard include need of mechanical ventilation and Septic shock requiring vasoconstrictor therapy. The minor standard include the following aspects:①. Respiratory frequency is more than 30 times in one minute,②. Oxygenation index less than or equal to 250.③. Multi lobar infiltration.④. Disturbance of consciousness or disorientation.⑤. Azotemia(BUN≥20mg/dl).⑥. Cytopenia(WBC<4.0×109/L).⑦. Thrombocytopenia(plt<10.0×109/L).⑧. Low temperature(T<36℃).⑨. Hypotensive needs stronger resuscitation of liquid. With the 1 main standard or above of 3 minor standard times can be diagnosed with severe pneumonia. Patients with mechanical ventilation Patients received the therapy of Protective bronchoalveolar Lavage. Bronchoalveolar lavage fluid send bacterial culture and drug sensitivity.Sputumg was collected by sterility sputum aspirating tube send bacterial culture and drug sensitivity.Results:Two methods of training result in gram negative bacteria mainly, including pseudomonas aeruginosa,bauman acinetobacter,klebsiella pneumoniae. Gram positive bacteria account for second,which is gived first place to methicillin resistant Staphylococcus aureus,and streptococcus pneumonia. Fungi accounted account for third,which are candida albicans and candida tropicalis. 49 cases of 60 patients sampled by PBAL were positive, the positive rate was 81.67%, 31 cases sampled by sterility sputum aspirating tube were positive, the positive rate was 51.67%.The positive rate of two methods were statistically significant difference(P<0.05). Treatment and prognosis: Protection of bronchoalveolar lavage fluid in patients with positive cultures were 39 cases, through drug sensitivity I select sensitive drugs, then they were clinical improvement. The X-ray suggest the focus absorption that have 35 cases. Because of severe basic diseases, 2 cases died, the mortality rate is 3.33%.Clinical comparison between protected bronchoalveolar lavage and sterility sputum aspirating tube on mechanical ventilated patients with severe pneumonitis:Protective bronchoalveolar lavage findings in specimens from the positive rate of bacteria, fungi and drug sensitive test was higher than sterility sputum aspirating tube,which have statistical significance(P < 0.05). Protective bronchoalveolar lavage acquire etiology diagnosis positive rate to be more instructive.The techniqueg of Protective bronchoalveolar lavage can not only obtain the accurate etiology, but also has a therapeutic effect of mechanical ventilation in patients with severe pneumonia.Conclusion:1 Protected bronchoalveolar lavage obtains detection rate of etiology in patients in patients of mechanical ventilation is higher than sterility sputum aspirating tube.2 Protected bronchoalveolar lavage obtains the etiology in patients of mechanical ventilation is greater accuracy than sterility sputum aspirating tube,and also more guiding significance to choose antibiotics, so as to shorten the time in ICU.3 Protected bronchoalveolar lavage obtains the etiology in patients of mechanical ventilation is more direct,and more accurate location than sterility sputum aspirating tube.