Effect of bronchoalveolar lavage on the clinical efficacy, inflammatory factors, and immune function in the treatment of refractory pneumonia in children

Dose-response relationship and predictive value of soluble B7-DC in bronchoalveolar lavage fluid and risk of refractory Mycoplasma pneumoniae pneumonia in children

This study was to investigate the clinical significance of soluble B7-dendritic cell (sB7-DC) concentration in bronchoalveolar lavage fluid (BALF) of children with Refractory Mycoplasma pneumoniae pneumonia (RMPP). A total of 298 patients with Mycoplasma pneumoniae pneumonia (MPP) were enrolled. Patients were divided into general MPP (GMPP) (n = 213) and RMPP groups (n = 85). Detection of sB7-DC and serum inflammatory factors in BALF was performed by ELISA. The relationship between sB7-DC and the risk of RMPP was assessed using restricted cubic spline (RCS) model. A base model for predicting RMPP was constructed using logistic regression analysis, and a compound model was created with the addition of sB7-DC in the base model. ROC curves were plotted to evaluate the predictive value of the model. Column line plots were plotted to assess the contribution of each variable to the outcome event. Calibration curves were plotted and the Hosmer-Lemeshow test (HL test) was performed to assess the calibration performance of the model. Decision curve analysis (DCA) plots were plotted to assess determine whether sB7-DC has clinical value. There was no statistical difference between sB7-H3 and sB7-H4 in the two groups (both p > 0.05). sB7-DC levels were higher in the RMPP group than in the GMPP group (91.66 [77.36, 122.5] pg/ml vs. 64.87 [47.07, 86.46] pg/ml, p < 0.001). RCS analysis showed that the risk of RMPP gradually increased with the increase of sB7-DC when sB7-DC > 76.505 pg/ml. Both the base model and the compound model constructed with independent correlates of RMPP had some predictive value, and the models were well-fitted. The column line graphs showed that the models had discriminative ability. Notably, the compound model had a higher predictive value, with a higher AUC value than the base model: 0.76 (0.65-0.87) versus 0.68 (0.54-0.81). The highest net benefit was close to 0.15 (only 0.1 in the base model). When the net benefit was >0, the high-risk threshold took on a wide range of values. sB7-DC in children with RMPP is an independent predictor of RMPP. sB7-DC helps to improve quantitative prediction of RMPP risk and accurately guide medical decisions.

Chest CT characterization of children with necrotizing pneumonia due to Mycoplasma pneumoniae infection

We summarize the chest CT manifestations and prognoses of children with Mycoplasma pneumoniae pneumonia combined with necrotizing pneumonia. We retrospectively analyzed the chest CT manifestations and prognoses of 155 cases of necrotizing pneumonia in children due to Mycoplasma pneumoniae infection and compared the differences in clinical features and laboratory indices between the group with unilateral monolobar necrosis of the lungs (Group A) and the group with unilateral multilobar and bilateral necrosis (Group B). The chest CT findings of the children in both groups revealed that the area of lung necrosis was confined to the unilateral monolobe in 124 children. The necrotic condition of the lungs included only hypodense shadows in 80 children (51.61%) and cystic cavities in the necrotic areas in 75 children (48.39%). Bronchoscopic manifestations: Endobronchitis was present in 135 children, ulcerative necrosis of the bronchi in 47, and occlusive bronchitis in four. A total of 101 children were followed up. A small percentage of patients have residual manifestations such as lobar atelectasis and bronchial wall changes. The number of days of fever and cases of respiratory distress were significantly greater in group B than in group A. Chest CT reveals pulmonary necrosis in children due to Mycoplasma pneumoniae infection: the area of pulmonary necrosis is mostly unilateral and unilobar, the lower lungs are predominant, and areas of reduced enhancement can be seen on enhanced CT. CT manifestations after clinical treatment may be approximately normal or leave a striped shadow, lung atelectasis, or pleural thickening.

Prophylactic fiberoptic bronchoscopy after sleeve lobectomy can reduce the incidence of postoperative pneumonia: a propensity score matching study

Background

Postoperative pneumonia (POP) predicts poor outcomes after lung surgery, especially for patients undergoing sleeve lobectomy. Fiberoptic bronchoscopy (FOB) is frequently used in the treatment of POP for patients receiving sleeve lobectomy. This study aimed to assess the effect of prophylactic FOB on the incidence of POP in these patients.

Methods

This is a single-center retrospective cohort study. Postoperative outcomes of patients who underwent sleeve lobectomy for central lung cancer from August 2005 to August 2020 in the West China Hospital were collected. The included patients were divided into two groups based on whether prophylactic FOB was performed, and the two groups were compared using propensity score matching (PSM).

Results

A total of 314 patients were included in this study. There were 166 patients in the aspirated group and 148 patients in the non-aspirated group. PSM resulted in 133 patients in each group. The aspirated group was associated with a lower incidence of POP (7.5% vs. 17.3%; P=0.03), shorter duration of antibiotic use (5.6±3.3 vs. 6.9±3.9 days; P=0.003), and shorter postoperative hospital stay (9.3±4.8 vs. 10.7±5.5 days; P=0.04).

Conclusions

Prophylactic FOB after sleeve lobectomy was associated with improved postoperative outcomes and might be recommended for patients undergoing sleeve lobectomy.

Clinical efficacy of bronchoalveolar lavage in the treatment of small airway diseases in children

Objective

This study aimed to evaluate the efficacy of bronchoalveolar lavage (BAL) in the treatment of children with small airway diseases.

Methods

Children [n = 112; boys: 76, girls: 36 (ratio 2.1:1); age range: 1 month-10 years; median age: 12 months] with small airway diseases diagnosed by high-resolution computed tomography (HRCT) were enrolled in this study. The patients were assigned to either the BAL group (BAL and conventional therapy) or the control group (conventional therapy only). The duration of cough, fever, wheezing, hospitalization duration, disease course before admission, treatment cost, HRCT recovery time, and re-hospitalization rate were compared between the two groups.

Results

The median disease course before admission of the BAL group patients was longer than that of the controls (p = 0.006). The duration of cough and wheezing in the BAL group was significantly longer than that in the control group (p = 0.012 and p = 0.001, respectively). The recovery time of cough, the re-hospitalization rate, and the total expenditure incurred for the BAL group were lower than those for the control group (p = 0.027, p = 0.026, and p = 0.000, respectively). At 2 months after discharge, the small airway lesions were found to be absorbed in 86.2% of BAL group patients vs. 64.1% of control group patients. At 6 months after discharge, the lesions were not fully absorbed in 3.4% of the BAL group patients compared to 20.5% in the control group patients.

Conclusion

BAL is suitable for patients with a long disease course before admission, a long duration of coughing, and recurrent wheezing. BAL treatment of small airway diseases in children can promote the disappearance of clinical symptoms, accelerate the improvement of imaging, reduce the rate of re-hospitalization, and reduce the cost of treatment.

Brochoscopic Airway Clearance Therapy vs. Conventional Sputum Aspiration: The Future of Flexible Brochoscopes in Intensive Care Units?

(1) Background: The aim of our study is to investigate the effectiveness of bronchoscopic airway clearance therapy (B-ACT) on severe pneumonia (SP) patients with invasive mechanical ventilation (IMV) in the intensive care unit (ICU). (2) Methods: Our study retrospectively enrolled 49 patients with sputum aspiration and 99 patients with B-ACT, and the latter were divided into the ≤once every 3 days group (n = 50) and >once every 3 days group (n = 49). (3) Results: We found most laboratory blood results were significantly improved in the B-ACT group as compared with those in sputum aspiration group (p < 0.05). Patients in the B-ACT group and those in ≤once every 3 days group also had significantly better survival to hospital discharge than those in their counterpart groups (Logrank p < 0.001). In patients with cardiopulmonary diseases or positive cultures for bacteria, the B-ACT group and those in the ≤once every 3 days group had significantly better survival outcomes to discharge than those in their counterpart groups (Logrank p < 0.001). B-ACT and the average frequency of ≤once every 3 days had significantly better impact on survival outcomes than their counterpart groups (HR: 0.444, 95% CI: 0.238-0.829, p = 0.011; HR: 0.285, 95% CI: 0163-0.498, p < 0.001). (4) Conclusions: In the future, flexible bronchoscopes may paly an important role in ACT for SP patients with IMV.

Pediatric adenovirus pneumonia: clinical practice and current treatment

Adenovirus pneumonia is common in pediatric upper respiratory tract infection, which is comparatively easy to develop into severe cases and has a high mortality rate with many influential sequelae. As for pathogenesis, adenoviruses can directly damage target cells and activate the immune response to varying degrees. Early clinical recognition depends on patients' symptoms and laboratory tests, including those under 2 years old, dyspnea with systemic toxic symptoms, atelectasis or emphysema in CT image, decreased leukocytes, and significantly increased C-reaction protein (CRP) and procalcitonin (PCT), indicating the possibility of severe cases. Until now, there is no specific drug for adenovirus pneumonia, so in clinical practice, current treatment comprises antiviral drugs, respiratory support and bronchoscopy, immunomodulatory therapy, and blood purification. Additionally, post-infectious bronchiolitis obliterans (PIBO), hemophagocytic syndrome, and death should be carefully noted. Independent risk factors associated with the development of PIBO are invasive mechanical ventilation, intravenous steroid use, duration of fever, and male gender. Meanwhile, hypoxemia, hypercapnia, invasive mechanical ventilation, and low serum albumin levels are related to death. Among these, viral load and serological identification are not only "gold standard" for adenovirus pneumonia, but are also related to the severity and prognosis. Here, we discuss the progress of pathogenesis, early recognition, therapy, and risk factors for poor outcomes regarding severe pediatric adenovirus pneumonia.

Early molecular markers of ventilator-associated pneumonia in bronchoalveolar lavage in preterm infants

INTRODUCTION

Ventilator-associated pneumonia (VAP) constitutes a serious nosocomial infection. Our aim was to evaluate the reliability of cytokines and oxidative stress/inflammation biomarkers in bronchoalveolar lavage fluid (BALF) and tracheal aspirates (TA) as early biomarkers of VAP in preterm infants.

METHODS

Two cohorts were enrolled, one to select candidates and the other for validation. In both, we included preterms with suspected VAP, according to BALF culture, they were classified into confirmed VAP and no VAP. Concentration of 16 cytokines and 8 oxidative stress/inflammation biomarkers in BALF and TA was determined in all patients.

RESULTS

In the first batch, IL-17A and TNF-α in BALF, and in the second one IL-10, IL-6, and TNF-α in BALF were significantly higher in VAP patients. BALF TNF-α AUC in both cohorts was 0.86 (sensitivity 0.83, specificity 0.88). No cytokine was shown to be predictive of VAP in TA. A statistically significant increase in the VAP group was found for glutathione sulfonamide (GSA) in BALF and TA.

CONCLUSIONS

TNF-α in BALF and GSA in BALF and TA were associated with VAP in preterm newborns; thus, they could be used as early biomarkers of VAP. Further studies with an increased number of patients are needed to confirm these results.

IMPACT

We found that TNF-α BALF and GSA in both BALF and TA are capable of discriminating preterm infants with VAP from those with pulmonary pathology without infection. This is the first study in preterm infants aiming to evaluate the reliability of cytokines and oxidative stress/inflammation biomarkers in BALF and TA as early diagnostic markers of VAP. We have validated these results in two independent cohorts of patients. Previously studies have focused on full-term neonates and toddlers and determined biomarkers mostly in TA, but none was exclusively conducted in preterm infants.

Effects of bronchoalveolar lavage on Mycoplasma Pneumoniae pneumonia: A propensity score matched-cohort study

BACKGROUND

The purpose of this study was to evaluate the efficacy and safety of BAL in treating MPP.

METHODS

From January 2013 to January 2019, 1,689 pediatric patients with MPP were analyzed retrospectively. Patients were subdivided into BAL group and non-BAL group according to whether they received BAL treatment within seven days after admission. The propensity score matching method matched patients' baseline characteristics (1:1). The primary outcomes were hospital stays and the cure rate. Secondary outcomes included mortality, co-infection, repeat hospitalization within 30 days, and total cost of treatment.

RESULTS

After matching, 524 patients (BAL: 262; control: 262) were recorded. The BAL group had significantly shorter hospital stays (OR: 0.5, 95% CI: 0.4-0.7). Meanwhile, BAL did not significantly modify the cost, co-infection rate, and mortality. In subgroup analyses, the group with BAL intervention within three days had a significantly shorter hospital stay (OR: 0.4, 95% CI: 0.3-0.5) compared with the group with BAL intervention three days after admission.

CONCLUSIONS

Early BAL intervention is a better treatment than conventional drug therapy alone, and no significant complications were seen in this study. BAL intervention has an excellent clinical benefit. The earlier the intervention, the better the effect.