Early treatment of atelectasis by bronchoscopy in craniotomy patients

Objective To investigate the safety and effects of early bronchoscopy on atelectasis of the ventilation patients,whom had exprienced craniotomy for severe cranial trauma and hemorrhage.Methods Fifty-five patients suffered from severe cranial trauma and hemorrhage with Glascow coma scores (GCS) less than 8 complicated by atelectasis after craniotomy were early given sputum suction by bronchoscope via extratracheal intubation and broncho-alveolar lavage (BAL) during tracheal intubation and mechanical ventilation.During the treatment,patients' consciousness,vital signs and arterial blood gas were closely monitored.The relevant data,before,during (5,10,and 25 minutes),bronchoscopy treatment completed and 30 minutes after bronchoscopy,were recorded and analyzed.Results Eighty-two time of bronchoscopies and 111 time of local BALs in 55 patients were completed and were effective for atelectasis.The patient's GCS (5.6 ± 2.5 vs.5.4 ± 2.6,P＞ 0.05),heart rate (HR),respiratory rate (RR),systolic blood pressure (SBP),blood oxygenous saturation (SaO2) were not deteriorated during bronchoscopy.Compared with pre-bronchoscopy,the HR and SBP decreased [HR (bpm):88.2 ± 14.2 vs.98.2± 18.3,SBP (mm Hg,1 mm Hg=0.133 kPa):110.6 ± 18.2 vs.118.4 ± 18.5,both P＜0.05],and SaO2 increased (0.982 ±0.022 vs.0.945 ± 0.035,P＜0.05),pH,arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) had no significant changes during bronchoscopy.There was obviously increased in PaO2 (mm Hg:84.5 ± 14.4,81.6 ± 18.2 vs.76.2 ± 15.4,both P＜0.05),and decreased in PaCO2 (mm Hg:27.0 ± 12.8,29.3 ± 18.2 vs.36.5 ± 11.6,both P＜0.05) respectively,significantly decreased in alveolar arterial pressure of oxygen difference [P(A-a)O2] at 10 minutes and 25 minutes,and at the time bronchoscopy treatment completed and the time 30 minutes after compared with before bronchoscopy (mm Hg:36.1 ± 4.7,32.4 ± 6.2,32.5 ± 5.2,31.2 ± 7.2 vs.38.5 ± 5.6,all P＜0.05).All patients had not encounter side effects related with bronchoscopy and ventilation.Conclusion The bronchoscope via extratracheal intubation for sputum suction and BAL were safe and effective treatment to the patients suffered from severe cranial trauma or hemorrhage complicated by atelectasis after craniotomy during mechanical ventilation,without obvious changes of the vital signs. Key words: Severe cranial trauma; Hemorrhage; Craniotomy; Atelectasis; Bronchoscopy; Early intervention