Selective Large Volume Broncholavage for Acute Exacerbation of Bronchiectasis by Bronchonscopy_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 LiuZhiguang , WuHuaiqiu , ZhangWeidong , DengHongying , TanJianlong , LiJianming , JiangGang , LiuNian , TaoYin

Department of Respiratory Medicine, Hunan Provincial Hospital, Changsha, Hunan, 410005, China;

Corresponding?author：

LiuZhiguang, Email: liuzhiguang0404@126.com

Keywords：

Bronchoscopy; Large volume lavage; Bronchiectasis

DOI：

10.7507/1671-6205.2014140

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Objective To evaluate the efficacy and safety of selective large volume broncholavage by bronchonscopy in treatment of patients with acute exacerbation of bronchiectasis. Methods A single-center randomized control,non-blind clinical trial was conducted.A total of 65 patients were randomly divided into Group A(large volume broncholavage group,n=21),Group B (mini- large volume broncholavage group,n=22) and Group C (control group,n=22).All patients received routine therapy of acute exacerbation of bronchiectasis while additional broncholavage was administered in the treatment groups for only once.Warm normal saline solution was instilled for Group A at volume of 500 to 2 000 mL and for Group B at volume of 100 to 200 mL.The baseline characteristics,Simplified Clinical Pulmonary Infection Score(CPIS) and C-reactive protein (CRP) were recorded at the first and on 7^th day.The duration of antibiotic use,the length of hospital stay and total effective rate were compared among three groups. Results The lavage volume was (1 250.0±403.3)mL for Group A and (141.0±41.2)mL for Group B.The length of hospital stay and duration of antibiotic use were (8.4±1.0)d and (7.9±1.1)d respectively,shorter than those in Group B[(13.5±1.6)d,(11.6±2.4)d] and Group C[(15.3±3.2)d,(13.3±2.6)d] with significant difference between three groups(all P<0.05).The total effective rates was 95.23% in Group A,higher than those in Group B (81.82%) and Group C (68.19%)(all P<0.05).The CPIS on the 7^th day of Group A was 1.9±1.4,lower than that in Group B (2.7±0.8) and Group C (3.7±0.9)(P<0.05).The CRP of Group A decreased more quickly than Group B and Group C.The adverse events occurred in Group A and Group B including transient hypoxemia (23.81%,9.09%, respectively),tarchycardia(100%,68.18%, respectively),airway mucosal injury(38.09%,13.64%, respectively) and elevated blood pressure (19.05%,13.64%, respectively). Conclusion Selective large volume broncholavage through bronchonscopy is an effective and safe treatment for patients with acute exacerbation or bronchiectasis.

Citation： LiuZhiguang, WuHuaiqiu, ZhangWeidong, DengHongying, TanJianlong, LiJianming, JiangGang, LiuNian, TaoYin. Selective Large Volume Broncholavage for Acute Exacerbation of Bronchiectasis by Bronchonscopy. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(6): 574-578. doi: 10.7507/1671-6205.2014140 Copy

1.	田欣倫,吳翔,徐凱峰,等.成人支氣管擴張患者的病因及臨床特點分析.中國呼吸與危重監護雜志,2013,12:576-580.
2.	Shlomi D,Kramer MR,Fuks L,et al.Endobronchial drainage of lung abscess:the use of laser.Scand J Infect Dis,2010,42:65-68.
3.	Mansharamani NG,Koziel H.Chronic lung sepsis:lung abscess,bronchiectasis,and empyema.Curr Opin Pulm Med,2003,9:181-185.
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9.	成人支氣管擴張癥診治專家共識編寫組.成人支氣管擴張癥診治專家共識.中華結核和呼吸雜志.2012,35:485-492.
10.	Rosemary J Boyton.Bronchiectasis.Medicine,2012,40:267-272.
11.	Rupp CH,Wasserman K,Ogawa M,et al.Bronchopulmonary fluids in pulmonary alveolar proteinosis.J Allergy Clin Immunol,1973,51:227-237.
12.	Caruso P,Denari S,Ruiz SA,et al.Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia.Criti Care Med,2009,37:32-38.
13.	Scala R,Naldi M,Maccari U.Research Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia.Crit Care,2010,14:R80.
14.	王正維,魏立平,何晟,等.經纖支鏡用大量生理鹽水肺泡灌洗治療肺膿腫的臨床研究.中國醫藥指南,2011,9:339-340.
15.	Cheng SL,Chang HT,Lau HP,et al.Pulmonary alveolar proteinosis:treatment by bronchofiberscopic lobar lavage.Chest,2002,122:1480-1485.
16.	Edis EC,Tabakoglu E,Caglar T,et al.Treatment of a primary pulmonary alveolar proteinosis case with severe hypoxaemia by using segmental lavage technique.Ann Acad Med Singapore,2007,36:871-872.
17.	Luisetti M,Kadija Z,Mariani F,et al.Therapy options in pulmonary alveolar proteinosis.Ther Adv Resp Dis,2010,4:239-248.
18.	Chesnutt MS,Nuckton TJ,Golden J,et al.Rapid alveolar epithelial fluid clearance following lung lavage in pulmonary alveolar proteinosis.Chest,2001,120:271-274.
19.	Schmitt GS,Ohar JM,Kanter KR,et al.Indwelling transbronchial catheter drainage of pulmonary abscess.Ann Torac Surg,1988,45:43-47.

1. 田欣倫,吳翔,徐凱峰,等.成人支氣管擴張患者的病因及臨床特點分析.中國呼吸與危重監護雜志,2013,12:576-580.
2. Shlomi D,Kramer MR,Fuks L,et al.Endobronchial drainage of lung abscess:the use of laser.Scand J Infect Dis,2010,42:65-68.
3. Mansharamani NG,Koziel H.Chronic lung sepsis:lung abscess,bronchiectasis,and empyema.Curr Opin Pulm Med,2003,9:181-185.
4. Mwandumba HC,Beeching NJ.Pyogenic lung infection.Tactors for predicting clinical outcome of lung abscess and thoracic empyema.Curr Opin Pulm Med,2000,6:234-239.
5. 李強,白沖,主編.呼吸內鏡學.上海:上海科學技術出版社,2003,317-318.
6. Finklea JD,Khan G,Thomas S,et al.Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis.Respir Med,2010,104:816-821.
7. 中華醫學會呼吸病學分會.診斷性可彎曲支氣管鏡應用指南(2008年版).中華結核和呼吸雜志,2008,31:14-17.
8. Singh N,Rogers P,Atwood CW,et al.Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit.Am J Respir Crit Care Med,2000,162:505-511.
9. 成人支氣管擴張癥診治專家共識編寫組.成人支氣管擴張癥診治專家共識.中華結核和呼吸雜志.2012,35:485-492.
10. Rosemary J Boyton.Bronchiectasis.Medicine,2012,40:267-272.
11. Rupp CH,Wasserman K,Ogawa M,et al.Bronchopulmonary fluids in pulmonary alveolar proteinosis.J Allergy Clin Immunol,1973,51:227-237.
12. Caruso P,Denari S,Ruiz SA,et al.Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia.Criti Care Med,2009,37:32-38.
13. Scala R,Naldi M,Maccari U.Research Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia.Crit Care,2010,14:R80.
14. 王正維,魏立平,何晟,等.經纖支鏡用大量生理鹽水肺泡灌洗治療肺膿腫的臨床研究.中國醫藥指南,2011,9:339-340.
15. Cheng SL,Chang HT,Lau HP,et al.Pulmonary alveolar proteinosis:treatment by bronchofiberscopic lobar lavage.Chest,2002,122:1480-1485.
16. Edis EC,Tabakoglu E,Caglar T,et al.Treatment of a primary pulmonary alveolar proteinosis case with severe hypoxaemia by using segmental lavage technique.Ann Acad Med Singapore,2007,36:871-872.
17. Luisetti M,Kadija Z,Mariani F,et al.Therapy options in pulmonary alveolar proteinosis.Ther Adv Resp Dis,2010,4:239-248.
18. Chesnutt MS,Nuckton TJ,Golden J,et al.Rapid alveolar epithelial fluid clearance following lung lavage in pulmonary alveolar proteinosis.Chest,2001,120:271-274.
19. Schmitt GS,Ohar JM,Kanter KR,et al.Indwelling transbronchial catheter drainage of pulmonary abscess.Ann Torac Surg,1988,45:43-47.

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Selective Large Volume Broncholavage for Acute Exacerbation of Bronchiectasis by Bronchonscopy

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