Abstract

BACKGROUND:

We hypothesized that fiberoptic bronchoscopy can contribute to mesenteric ischemia and bacterial translocation.

OBJECTIVE:

To test this hypothesis we investigated in patients undergoing bronchoscopy mesenteric blood flow and markers in association with ischemia reperfusion injury.

PATIENT:

Forty-seven consecutive patients requiring diagnostic fiberoptic bronchoscopy were studied.

MEASUREMENTS:

Parameters evaluated were superior mesenteric artery Doppler sonography, oxidative stress mediators, arterial blood gases, blood cultures pre-fiberoptic bronchoscopy, and 1st, 4th, and 24th hr post-fiberoptic bronchoscopy.

MAIN RESULTS:

After bronchoscopy; PaO2 decreased by 21.8% +/- 1.5% (range 6-40), and remained low at all time points (p = 0.0001, p = 0.0001, p = 0.008). Flow volume decreased by 38.8% +/- 14.9% (range 6-72), and remained low at 1st and 4th hr (p = 0.0001, p = 0.01). Resistive and pulsatile index increased at 1st hr (p = 0.0001, p = 0.001) and 4th hr (p = 0.018, p = 0.045). Myeloperoxidase and malondialdehyde increased at 1st hr (p = 0.0001) and 4th hr (p = 0.037, p = 0.028). Corresponding glutathione and catalase decreased at 1st hr (p = 0.0001), and glutathione remained significant at 4th and 24th hr (p = 0.0001, p = 0.003). Correlation between flow volume and PaO2 (r = .71, p = 0.0001), myeloperoxidase (r = -.39, p = 0.05), glutathione (r = .41, p = 0.03) was significant. Nine of 47 (19.1%) had fever, and 3 of 47 (6.4%) had gram-negative bacteremia.

CONCLUSION:

Fiberoptic bronchoscopy is associated with decreased mesenteric blood flow, which may place the patient at risk for mesenteric ischemia and gastrointestinal bacterial translocation.