Effects of bronchoscopic alveolar lavage–assisted mechanical ventilation on postoperative pulmonary infection and inflammatory factors in patients undergoing lung cancer surgery

TL;DR

This study shows that bronchoscopic alveolar lavage-assisted mechanical ventilation improves recovery and reduces inflammation in lung cancer surgery patients with postoperative pulmonary infection.

Contribution

The novel contribution is demonstrating that BAL-assisted MV outperforms standard MV in managing postoperative pulmonary infection and modulating inflammatory markers.

Findings

BAL-assisted MV significantly reduced infection control time, ventilation duration, and inflammatory marker levels compared to standard MV.

Patients in the BAL-assisted MV group showed greater improvements in respiratory function and clinical effectiveness rates.

Both groups experienced improved lung compliance and blood gas indices, but effects were more pronounced with BAL assistance.

Abstract

Patients undergoing lung cancer (LC) surgery often develop pulmonary infection (PI) due to poor sputum excretion ability leading to accumulation of secretions. Bronchoalveolar lavage (BAL) during fiberoptic bronchoscopy can be used to clear respiratory secretions and serve as a vehicle to locally deliver antibiotics that fight infection.

This study explored the clinical efficacy of BAL‑assisted mechanical ventilation (MV) in patients with postoperative PI and its influence on inflammatory parameters.

A total of 90 LC patients with postoperative PI were enrolled and divided into an MV group (n = 45) and a BAL‑assisted MV group (n = 45). Therapeutic effects, respiratory mechanics, lung function parameters, blood gas indices, and levels of inflammatory parameters in peripheral blood were compared between the groups.

In comparison with the MV group, the PI control time, MV duration, temperature recovery time, and Clinical Pulmonary Infection Score of patients in the BAL‑assisted MV group were greatly reduced. In both groups, airway resistance, peak airway pressure, and work of breathing decreased, while lung compliance increased. Maximum minute ventilation, total lung capacity, forced expiratory volume in 1 second, and maximum mid‑expiratory flow were substantially enhanced following each treatment. In addition, post‑treatment arterial oxygen pressure and saturation, pH value, and the ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration increased, while partial pressure of carbon dioxide decreased in both groups. The levels of inflammatory markers (high‑sensitivity C‑reactive protein, procalcitonin, tumor necrosis factor α, high‑mobility group box 1, interleukin 6, and macrophage inflammatory protein 1α) in peripheral blood were decreased regardless of the treatment method (all P <0.05). All these findings were more pronounced in the BAL‑assisted MV group. Clinical effective rate in the BAL‑assisted MV group was higher than in the MV group (93.33% vs 77.78%; P <0.05).

BAL‑assisted MV can achieve better results in treating postoperative PI than MV alone, effectively improving respiratory function and reducing systemic inflammatory response.

Figures