Clinical Application Of Bronchoalveolar Lavage In Children With Severe Pulmonary Infection

Objective: By analyzing bronchoalveolar lavage, to explore major pathogens of severe pulmonary infection children, to understand the degree of lung local inflammatory cytokines and therapeutic effects in different pathogens, to clarify its clinical value in children with severe pulmonary infection.Method: Totally 205 severe pulmonary infection children admitted in PICU of Hunan Children’s Hospital and underwent bronchoalveolar lavage from July 2014 to April 2015 were studied. Subjects were divided to 4 groups according to different pathogens to bacteria group, viruses group, mixed group, other groups,each group were compared with inflammatory cytokines(such as IL-23, TNF-α) levels, and after bronchoalveolar lavage bronchial symptoms, ventilation and ventilatory function.Results:(1)Pathogen in children with severe pulmonary infection mainly is bacteria and viruses, 28.8% of viruses, 23.9% of bacteria, bacteria are gram-negative bacteria in the majority, accounting for 63.5%, Klebsiella pneumoniae and Acinetobacter baumannii is a major Gram-negative bacteria and the main drug-resistant, PICU multi-drug-resistant pathogens, accounting for 65.9%.(2)IL-23 levels of bacterial infections, viral infections, mixed infec- tions, other infections in bronchoalveolar lavage fluid were 531.74±67.60, 516.96±72.88, 559.60±80.31, 488.71±78.86 pg/ml, TNF-α levels were 4.04 ± 0.55, 3.82 ± 0.67, 4.08 ± 0.58, 3.71±0.64ng/ml, IL-23 and TNF-α expression levels in BALF level of mixed infection were high, followed by bacterial infection, IL-23, TNF-α levels in BALF of different pathogens were significantly(P <0.01), white blood cell count, procalcitonin, C-reactive protein of different pathogen were no significant difference(P>0.05), IL-23 levels and TNF-α levels in BALF were positively correlated, both of which have a synergistic effect in anti-infective, and a direct response to local lung inflammation.(3)After bronchoalveolar lavage, PCO2 partial pressure decreased and oxygenation index increased, cough, shortness of breath and fever is decrease in children with severe pulmonary infection, which improve ventilation and ventilatory function, improve the clinical symptoms, effect of the bacteria group is 35 cases, effect of the virus group is 43 cases, effect of mixed group is 20 cases, effect of other group is 28 cases, viral infection and bacterial infection treatment effect is obvious, differences among the four groups was statistically significant(P <0.01).Conclusions:Bronchoalveolar lavage helps clear pathogens in children with severe pulmonary infection; can detect lung local inflammatory factors(such as IL-23, TNF-α) levels, which is highly expressed in a mixed infection; helps to improve ventilation and ventilatory function, improve symptoms, improve efficacy in children with severe pulmonary infections, especially for the individual bacterial or viral infections, so bronchial lavage has important clinical value in children with severe lung infection.