الفهرس 
Chapter (1): PneumoniaOnly 14 pages are availabe for public view
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Abstract
The study aimed to assess the efficacy of incorporating FB into routine care for critically ill patients admitted to the ICU following aspiration events and requiring MV.
The results demonstrated that patients in group B, who received airway suction using FB in addition to routine care, experienced several significant advantages compared to group A receiving routine care alone. Notably, group B showed significantly lower chest echography and procalcitonin pulmonary infection scores (CEPPIS score) and improved organ function (lower SOFA scores) after 72 hours and 7 days of intubation. The use of flexible bronchoscopy was associated with a lower proportion of positive lung ultrasound (U/S) findings and purulent tracheal secretions, indicating a potential role in preventing or managing aspiration pneumonia. Additionally, group B had a significantly lower proportion of positive sputum culture results, further supporting the positive impact of flexible bronchoscopy on infection control.
Furthermore, patients in group B experienced a shorter length of hospital stay and lower mortality rates compared to group A, indicating improved clinical outcomes. Laboratory findings supported the positive impact of bronchoscopy on infection control, with lower procalcitonin levels in group B after 72 hours and 7 days of intubation.
The study contributes valuable insights into the potential benefits of flexible bronchoscopy in managing aspiration-related complications in critically ill patients. These findings underscore the importance of timely and effective interventions to optimize patient outcomes in the ICU setting. While the results are promising, further research with multi-center studies is necessary to validate and generalize these findings and better understand the underlying mechanisms behind the observed outcomes. If confirmed, the integration of flexible bronchoscopy into routine care protocols could enhance patient management and lead to improved clinical outcomes for critically ill patients with aspiration events.
Summary of our results:
After 7 days of intubation, the median CEPPIS score was 4, IQR=2–6 for all patients, and it was statistically significantly lower in group B (median = 3, IQR=2– 6) compared to group A (median = 4, IQR= 2–8, P = 0.017).
After 7 days of intubation, the median SOFA score was 6, IQR=3–9 for all patients, and it was statistically significantly lower in group B (median=5, IQR=3–9) compared to group A (median=7, IQR= 4–9, P=0.038).
No significant differences in GCS between group A and B at intubation or after 72 hours (P=0,056, P=0,435 respectively). The GCS was statistically significantly higher in group B (median = 14, IQR=8–15) compared to group A (median = 10, IQR= 6–14, P = 0.002) after 7 days of intubation.
The Spo2 was statistically significantly higher in group B (mean = 92.9±3) compared to group A (mean = 91±8.2, P=0.042) after 7 days of intubation.
The mean RR were statistically significantly higher in group A compared to the group B at 3 days and 7 days after intubation (P <0.05).
Seven days after intubation, 105 patients (58.3%) had positive signs for pneumonia detected by lung U/S, and the proportion of positive lung U/S was statistically significantly lower in group B (32.2%) compared to group A (84.4%, P < 0.001).
Seven days after intubation, 87 patients (48.3%) had purulent tracheal secretions detected by suctioning, and the proportion of observing purulent tracheal secretions was statistically significantly lower in group B (45.6%) compared to group A (51.1%, P = 0.011).
Patients who underwent FB after aspiration events had a 66.2% lower risk to develop aspiration pneumonia compared to patients undergoing routine care alone (Relative risk = 66.2%).
The mean length of MV was 7.6 days (SD = 5.5) with a statistically significantly shorter length of MV in group B (Mean = 6, SD = 2.4) compared to group A (Mean = 9, SD = 7.1, P < 0.001).
The mean length of hospital stay was 11.9 days (SD = 5.5) with a statistically significantly shorter length of stay in group B (Mean = 9.6, SD = 2) compared to group A (Mean = 14.1, SD = 6, P < 0.001). The overall mortality rate was 30% in 28 days of follow-up.
The mortality rate was statistically significantly lower in group B (20%) compared to group A (40%, ARR = 20%, RR = 50%).
The mean level of procalcitonin was statistically significantly higher in the group A compared to group B (P < 0.05). No significant differences in the mean levels of TLC or CRP between group A or B at T3 (P > 0.05).