Fiberoptic Bronchoscopy in Severe Ventilator-associated Pneumonia

The Clinical Effect of Fiberoptic Bronchoscopy in Management of Adult Patients With Severe Ventilator-associated Pneumonia; a Randomized Controlled Trial

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.

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