Influence of the timing of bronchoscopic alveolar lavage on children with adenovirus pneumonia: a comparative study

Abstract

Background Adenovirus pneumonia is prone to severe clinical and imaging manifestations in children. Bronchoscopic alveolar lavage (BAL) is an important adjunctive therapy for patients with severe imaging findings. The study aimed to evaluate the effect of the timing on the efficacy of bronchoalveolar lavage in children with adenovirus pneumonia. Methods This study included 134 patients with adenovirus pneumonia treated with BAL at Guangzhou Women and Children's Medical Center from January 2019 to January 2020.They were classified into the severe and mild groups. Based on the timing of BAL, each group was divided into the early BAL layer (received BAL within 1–9 days of the illness course) and the late BAL layer (received BAL within 10–14 days of the illness course). The clinical data of patients with different BAL timings were analyzed in two groups. Results Among the 134 patients, 70 were categorized into the mild group and 64 were categorized into the severe group. Of the 134 patients, 42 patients received BAL early (mild group: n = 21 and severe group: n = 21) and 92 patients received BAL later (mild group: n = 49 and severe group: n = 43). In the mild group, the fever and hospital duration were shorter in patients who received BAL early than in those who received BAL later (p < 0.05). However, in the severe group, there were no statistically significant differences in the fever and hospital duration between patients who received BAL early and those who received BAL later. However, the need for mechanical ventilation and the incidence of BAL complications, such as new need for oxygen, were higher in patients who received BAL early than in those who received BAL later in the severe group (p < 0.05). Conclusion For mild adenovirus pneumonia, early BAL may shorten the fever and hospital duration. However, early BAL in severe cases might not shorten the course of the disease or improve prognosis and may even increase the risks of mechanical ventilation and BAL complications.

Timing of bronchoscopy and application of scoring tools in children with severe pneumonia

“…No AdV was detected, however, and the fungal population was surprisingly low. Conversely, this virus was found to be more common in the research conducted by Ma et al and Huang et al [14,17,18], especially with the development of pathogenic metagenomic technology.…”

“…These factors contribute to poor tolerance of BAL and increase the risk of complications. A recent study of AdV pneumonia also showed that there was no statistically significant difference in the duration of fever and hospital stay between patients in the severe group who received BAL in the early stages and those who received BAL in the later stages [18]. It is even speculated that receiving BAL in the early stages may increase the chance of mechanical ventilation and the occurrence of surgical complications in severe cases.…”

Clinical characteristics and half-year outcomes of 53 children with severe adenovirus pneumonia complicated with encephalitis or encephalopathy

“…It was reported that longer duration of fever (especially more than 10.5 days), acute respiratory failure, require invasive mechanical ventilation in the acute phase are more likely to develop BO [17,18]. Airway in ammation in children with BO increased, and the total number of white blood cells, neutrophil count, IL-1β, IL-6, IL-8 and TGF-β in the induced sputum were signi cantly increased [19], research in China reported that early BAL in severe HAdV pneumonia might not shorten the course of the disease or improve prognosis and may even increase the risks of mechanical ventilation and BAL complications [20], therefore, during the acute stage treatment of severe HAdV pneumonia complicated with encephalitis/ encephalopathy, the use and course of glucocorticosteroid and whether BAL therapy should be more aggressive to reduce airway in ammation and avoid progression to BO need further prospective study.…”

Pediatric adenovirus pneumonia: clinical practice and current treatment

“…Bronchoscopy combined with bronchoalveolar lavage can not only clamp the blocked mucus plug out of the small bronchi and effectively ease the clinical symptoms of children with pulmonary consolidation and atelectasis but also obtain alveolar lavage fluid, which is conducive to improving the detection efficiency of pathogens, adjusting drug usage, shortening the course of the disease, and reducing the hospitalization time needed ( 79 ). However, some studies have shown that BAL in mild cases can reduce the condition, while there is no significant difference in the incidence of pulmonary sequelae and death cases between the group receiving BAL in the early and late stages of SAP ( 114 ).…”