Fiberoptic Bronchoscopy in Severe Ventilator-associated Pneumonia

Benha University100 enrolled

Overview

This randomized controlled trial evaluated the clinical effect of fiberoptic bronchoscopy in the management of adult patients with severe ventilator-associated pneumonia (VAP). A total of 100 patients admitted to the Critical Care Department at Benha University Hospitals were enrolled and randomly assigned in equal numbers to two groups. The control group received standard therapy, including culture-guided antibiotics, lavage, and aspiration. The intervention group received the same treatment plus fiberoptic bronchoscopy for secretion clearance, lavage, and culture-directed antibiotic therapy. The primary outcome was the overall effective treatment rate, defined as the proportion of patients with significant or partial clinical improvement. Secondary outcomes included recovery time, length of intensive care unit stay, respiratory mechanics, inflammatory markers (C-reactive protein and procalcitonin), recurrence of pulmonary infection, and 28-day mortality. The study demonstrated whether the addition of fiberoptic bronchoscopy to conventional treatment improved clinical outcomes in patients with severe ventilator-associated pneumonia.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

100

Conditions

Ventilator-Associated Pneumonia Severe Pneumonia

Interventions

Other (Conventional Therapy)OTHER

Participants received standard therapy including culture-guided antibiotics, tracheal lavage, and aspiration. Sputum samples were collected from the lower trachea for culture and sensitivity testing to guide antibiotic selection.

Fiberoptic BronchoscopyPROCEDURE

Participants underwent fiberoptic bronchoscopy through the endotracheal tube for secretion clearance, sample collection, and alveolar lavage once daily for one week. Sterile sodium chloride solution with ambroxol hydrochloride was instilled, and antibiotics were administered immediately after lavage. Samples were cultured to guide antibiotic therapy.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adults aged 18-65 years * Patients of both sexes * Patients requiring mechanical ventilation * Development of pneumonia ≥ 48 hours after endotracheal intubation or ≥ 48 hours after extubation * Diagnosis of severe ventilator-associated pneumonia defined by a Modified Clinical Pulmonary Infection Score (CPIS) \> 6 Exclusion Criteria: * Refusal to participate * Presence of lung shadows prior to mechanical ventilation * Severe bleeding disorders or immune system diseases * Severe hemodynamic instability * Recent myocardial infarction or unstable arrhythmia * Tracheal stenosis or upper airway mass

Outcomes

Primary Outcomes

Overall Effective Treatment Rate

Proportion of patients achieving significant or partial clinical improvement based on resolution of symptoms, normalization of temperature and laboratory markers, negative sputum cultures, and radiologic improvement.

Time frame: Postoperatively (within 28 days of VAP diagnosis).

Secondary Outcomes

Recovery Time

Duration from diagnosis of ventilator-associated pneumonia (VAP) until Modified Clinical Pulmonary Infection Score (CPIS) decreased to below 6.

Time frame: Up to 28 days from diagnosis.

Length of intensive care unit (ICU) stay

Total number of days spent in the intensive care unit during the hospital admission.

Time frame: From intensive care unit (ICU) admission until discharge (maximum 28 days).