Mini-bronchoalveolar lavage with and without surfactant in the treatment of recurrent atelectasis in pediatric intensive care patients
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KeywordsMechanic Parameter Traditional Treatment Intensive Care Patient Peak Inspiratory Pressure Arterial Carbon Dioxide
Since traditional treatment of atelectasis is often insufficient to reopen the collapsed airways, mini-bronchoalveolar lavage (mini-BAL) is performed. We retrospectively compared the treatment effects of mini-BAL only and mini-BAL combined with surfactant in the treatment of pediatric ICU patients with recurrent atelectasis.
A retrospective analysis included a heterogeneous group of 18 mechanically ventilated pediatric ICU patients with recurrent atelectasis. Nine patients (mean age, 4.4 ± 3.4 years) who received surfactant after standard mini-BAL were compared with nine patients (mean age, 4.7 ± 3.0 years) who underwent only standard mini-BAL. Gas exchange and pulmonary mechanic parameters in the two groups were compared. The peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), paO2/FiO2, and partial arterial carbon dioxide pressure (paCO2) were analyzed with 3 × 2 multivariate analysis of variance, with the time of measurement (before treatment, 6 and 12 hours after treatment) as a within-subject factor and the type of treatment (mini-BAL only vs mini-BAL with surfactant) as a between-subject factor.
The groups did not differ in age (independent sample t test = 0.698). The parameters significantly changed with time after treatment (Wilks' λ = 0.027, F = 25.277, P < 0.001), and the treatment procedures had significantly different effects (time × treatment, Wilks' λ = 0.103, F = 6.070, P = 0.013). A significant univariate time-treatment interaction was not present only for SpO2 (F(2,32) = 2.167, P = 0.629). Subsequent analyses showed different effect of surfactant administration on PEEP compared with mini-BAL alone. In the mini-BAL only group, PEEP changed from 6.44 ± 1.13 cmH2O before treatment to 5.22 ± 0.83 cmH2O 6 hours after the treatment (P = 0.019), and remained the same 12 hours after the treatment. The group that received surfactant had significantly lower PEEP values compared with the mini-BAL only group 12 hours after the treatment (3.44 ± 0.72 before vs 5.22 ± 0.44 mmH2O after treatment, P = 0.025).
Mini-BAL is efficient in the treatment of recurrent atelectasis in pediatric ICU patients. Beneficial effects of surfactant administration after mini-BAL should be confirmed prospectively in a larger number of patients.