Effect of bronchoalveolar lavage on the heart rhythm and conduction of the children with severe pneumonia

Objective To observe the effect of bronchoalveolar lavage on the heart rhythm and conduction of children with severe pneumonia through monitoring the electrocardiogram change of different step of the bronchoalveolar lavage, for proving the safety of the operation of bronchoalveolar lavage from the perspective of cardiac electrophysiology. Method From July 2011 to March 2012, 30 patients who were hospitalized in pneumology department of Dalian Children′s Hospital and met the inclusion criteria and therapeutic indications of bronchoalveolar lavage were chosen. They were 3 to 12 years old, the average age was 5.3 years, including 17 boys and 13 girls, the ratio of boys and girls is 1.3∶1. Continuous sampling the electrocardiogram before and during the process including anesthesia, entering into glottis, lavage, aspiration, and revive, and recording the heart rate, rhythm amplitude and width of P wave, the PR interval, the form and width of QRS complex were also measured. The recorded data were analyzed and statistical analysis to reflect the change of the cardiac electrophysiology. Result The incidence of heart rate increase was 100.0%, 26 (86.7%) patients began to emerge after anesthesia, the rest of the patients also developed heart rate increase after the start of bronchoscopic operation. All patients had sinus tachycardia, and were most obvious in the progress of lavage and revive. In the process of entering into glottis, lavage, aspiration, 13 (43.3%)patients had arrhythmia episodes. Types of arrhythmia included sinus bradycardia, atrioventricular block and premature beat. Incidences of intraoperative arrhythmia compared with the pre- and post-operation were all statistically significantly different (P=0.00). The most common arrhythmia were premature beat, in 17 of the 30 cases there were premature beat including 9 cases with atrial premature beats and 8 cases ventricular premature contraction. Two patients had Ⅲ° atrioventricular block accompanied by serious sinus bradycardia. All kinds of arrhythmias except sinus tachycardia disappeared after the operation was ended. Five patients(16.7%) had PR interval prolongation. Five patients(16.7%) had incomplete right bundle branch block(IRBBB). Incidences of IRBBB compared with the pre-operation and post-operation were all not significantly different [13.3% (n=4) vs. 0(n=0) and 3.3% (n=1), all P>0.05]. Different operating progress made no significant difference in the measurement value of electrocardiogram[13.3% (n=4) vs. 0(n=0) and 3.3% (n=1), all P>0.05], but showed the most notable effect on heart rate. Conclusion Bronchoalveolar lavage can influence the heart rhythm and conduction, but most of the influence with pathological significance are transient. Cardiac electrophysiological changes were the most obvious in endotracheal operation with the risk of malignant arrhythmia but the risk is low, the bronchoalveolar lavage technique is safe. The contingency plans for dealing with all kinds of adverse reactions must be ready before the operations of bronchoalveolar lavage. During the procedure, the patient′s ECG changes should be closely monitored to reduce the incidence of adverse reactions. Key words: Bronchoalveolar lavage; Child; Electrocardiography; Cardiac electrophysiology