Tt. Bauer et al., Effects of bronchoalveolar lavage volume on arterial oxygenation in mechanically ventilated patients with pneumonia, INTEN CAR M, 27(2), 2001, pp. 384-393
Objective: To assess the effect of bronchoalveolar lavage (BAL) volume on a
rterial oxygenation in critically ill patients with pneumonia.
Design: Randomized clinical comparison.
Setting: Six-bed respiratory intensive care unit of a 850-bed tertiary care
university hospital.
Patients: Thirty-seven intubated and mechanically ventilated patients with
clinical suspicion of pneumonia. Interventions: Bronchoscopically guided pr
otected specimen brush (PSB) followed by either a "high volume" BAL (n = 16
, protected catheter, mean volume: 131 +/- 14 ml) or a "low volume" BAL (n
= 21, protected double-plugged catheter, 40 ml volume for all patients).
Measurements: Arterial oxygen tension/fractional inspired oxygen (PaO2/FIO2
) and mean arterial pressure (MAP) before and up to 24 h after the interven
tion. Bacterial growth in quantitative cultures. Analysis of variance for r
epeated measurements with inter-subject factors.
Results: All patients showed a lower PaO2/FIO2 ratio and higher MAP after t
he diagnostic procedure, without differences between the study arms (p = 0.
608 and p = 0.967, respectively). Patients with significant bacterial growt
h (p = 0.014) and patients without preemptive antibiotic (p= 0.032) therapy
showed a more profound and longer decrease in arterial oxygenation after t
he diagnostic procedure.
Conclusions: A decrease in the PaO2/FIO2 ratio was observed in all patients
after a combined diagnostic procedure, independent of the BAL volume used.
A significant bacterial burden recovered from the alveoli and no preemptiv
e antibiotic therapy were associated with a larger and longer-lasting decre
ase in arterial oxygenation.