The role of broncho-alveolar lavage in prevention of ventilator associated pneumonia and prediction of prognosis in mechanically ventilated trauma patients

Abstract

Purpose: The effect of early vs late broncho-alveolar lavage (BAL) on incidence of ventilator associated pneumonia (VAP), besides the cytokines level in both BAL fluids (BALF) and blood on patients’ outcome. Methods: Seventy mechanically ventilated trauma patients were enrolled and allocated into two equal groups early BAL (Group I) and late BAL (Group II). BALF and blood samples were obtained simultaneously. Samples were submitted for microbiological tests and determination of Interleukin 6 (IL6) and interleukin 8 (IL8) levels. Results: VAP incidence was significantly lower in group I (28.6%) than group II (60%) (P =0.008). IL6 in BALF was significantly different between both BAL groups (P=0.037) and VAP and non VAP cases (P=0.001), While, IL8 in BALF showed insignificant difference between similar groups. In a regression analysis, IL6 in BALF was a predictor for VAP development (OR 1.16, 95.0% CI: 1.021-1.218, P=0.004). BALF level of IL6 and IL8 showed significant difference between survivors and non-survivors (P=0.004) and (P=0.03) respectively. Conclusion: Early BAL reduces the incidence of VAP and improves the outcome of mechanically ventilated trauma patients, the use of IL6 and IL8 levels in BALF in combination with other biomarkers is a promising avenue for better VAP management.