Tuberc Respir Dis.  2003 Jan;54(1):71-79. 10.4046/trd.2003.54.1.71.

Continuous Positive Airway Pressure during Bronchoalveolar Lavage in Patients with Severe Hypoxemia

• An CH
• Lim SY
• Suh GY
• Park GY
• Park JW
• Jeong SH
• Lim SY
• Oui M
• Koh WJ
• Chung MP
• Kim H
• Kwon OJ

• KMID: 1883784
• DOI: http://doi.org/10.4046/trd.2003.54.1.71

Abstract

BACKGROUND: A bronchoalveolar lavage(BAL) is useful in diagnosing the etiology of bilateral pulmonary infiltrations, but may worsen the oxygenation and clinical status in severely hypoxemic patients. This study assessed the safety and efficacy of the continuous positive airway pressure(CPAP) using a conventional mechanical ventilator via a face mask as a tool for maintaining the oxygenation level during BAL.
METHODS
Seven consecutive patients with the bilateral pulmonary infiltrates and severe hypoxemia (PaO2/FIO2 ratio RESULTS
(1) Median age was 56 years(male:female=4:3). (2) The baseline PaO2 was 78+/-16 mmHg, which increased significantly to 269+/-116 mmHg(p=0.018) with CPAP. After the BAL, the PaO2 did not decrease significantly but returned to the baseline level after the CPAP was discontinued. The SpO2 showed a similar trend with the PaO2 and did not decrease to below 90 % during the duration of the study. (3) The PaCO2 increased and the pH decreased significantly after the BAL but returned to the baseline level within 30 min after the BAL. (5) No complications directly related to the BAL procedure were encountered. However, intubation was necessary in 3 patients(43 %) due to the progression of the underlying diseases.
CONCLUSION
In severe hypoxemic patients, CPAP using a face mask and conventional mechanical ventilator during a BAL might allow minimal alterations in oxygenation and prevent subsequent respiratory failure.

Keyword

Hypoxemia; Bronchoalveolar lavage; Continuous positive pressure ventilation

MeSH Terms

Anoxia*
Bronchoalveolar Lavage*
Bronchoscopes
Continuous Positive Airway Pressure*
Gases
Humans
Hydrogen-Ion Concentration
Intubation
Masks
Mouth
Oxygen
Respiratory Insufficiency
Ventilators, Mechanical
Vital Signs
Gases
Oxygen