To evaluate the value of early bronchoscopy intervention for prevention of early pulmonary infection and reduction of death rate in patients with severe brain surgery.

From January 2017 to September 2019, patients admitted to Neurosurgical Intensive Care Unit, Affiliated Jinhua Hospital, Zhejiang University School of Medicine after emergency brain surgery and ventilated for more than 24 hours were enrolled into this study. They were randomly divided into a treatment group and a control group. The control group was treated by the clinician according to the condition and given routine sputum suction treatment as needed. In the observation group, on the basis of the treatment for the control group, sputum aspiration and lavage with a bedside bronchoscope were given for the first time within 24 hours after operation, and then, as required, sputum aspiration and lavage with a bedside bronchoscope were given. Early pulmonary infection rates and 28-day mortality were compared between the two groups.

A total of 246 patients were enrolled, of whom 144 were male and 102 were female. They ranged in age from 19-94 years, with an average age of (58.52±14.42) years. The diagnoses included cerebral hemorrhage in 142 (57.72%) patients, cerebral infarction in 15 (6.10%), and cerebral trauma in 89 (36.18%). During the observation period, 111 patients were treated by bedside bronchoscopy for 1-5 times, with an average of (1.97±1.20) times. Sixty-eight patients had pulmonary infection with an overall infection rate of 37.64%, among whom 27 (24.32%) were in the treatment group and 41 (29.63%) in the control group, with no statistically significant difference between the two groups (P＞0.05). Eighty-seven patients died in 28 days after admission, with an overall mortality of 35.37%, among whom 33 (29.73%) were in the treatment group and 54 (40.00%) in the control group, with no statistically significant difference between the two groups (P＞0.05). Sub-group analysis revealed that the infection rate of patients with brain trauma (17.02% vs 38.10%) and the death rate of patients with cerebral hemorrhage (20.69% vs 39.29%) in these two groups had statistical differences (P=0.025 and 0.019, respectively). The peak value of blood inflammation index in patients with early secondary pulmonary infection in the observation group was significantly lower than that of the control group (P＜0.05).

Early bronchoscopic sputum aspiration and lavage can help to reduce the rate of early pulmonary infection of patients with brain trauma, the mortality of patients with cerebral hemorrhage, and early pulmonary inflammatory reaction and absorption of toxins in patients with severe brain surgery and is worthy of clinical promotion.