Journal of thoracic disease · 2026
The efficacy and safety of fiberoptic bronchoscopy-guided bronchial alveolar lavage combined with local drug injection in the treatment of severe pneumonia: a systematic review and meta-analysis based on randomized controlled trials.
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Wang Chuan, Li Yang, Shi Jinying, Xia Jingrong, Gu Xiaojing, Chen Jie, Chai Shukun
Аннотация
BACKGROUND: The combined evidence and safety of fiberoptic bronchoscopy (FB)-guided bronchial alveolar lavage (BAL) combined with topical drug administration for the treatment of severe pneumonia has not been systematically evaluated. This study aimed to systematically evaluate the efficacy and safety of FB‑guided BAL combined with local drug injection for severe pneumonia.
METHODS: This study searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI) and Wanfang Data to collect randomized controlled trials (RCTs) published up to 10 May 2025 on the combined use of BAL and local drug injection in the treatment of patients with severe pneumonia. The primary outcome was clinical efficacy rate, with secondary outcomes including intensive care unit (ICU) length of stay, 28-day case fatality rate, and adverse events.
RESULTS: A total of 30 RCTs (2,742 patients) were included. Clinical efficacy rate: significantly improved in the combination therapy group [risk ratio (RR) =1.25, 95% confidence interval (CI): 1.19-1.31, P<0.001], with the greatest relative benefit observed in the middle-aged group (RR =1.33). Subgroup analysis by drug type showed that expectorants achieved the largest absolute improvement [absolute risk difference (ARD) 23.7%], while antibiotics demonstrated the most consistent efficacy. ICU length of stay: reduced by an average of 4.73 days (95% CI: -5.57 to -3.88, P<0.001). Safety: overall adverse events showed no difference (RR =2.13, 95% CI: 0.80-5.66). In the pediatric subgroup, based on two small studies (60 patients), the estimate was highly imprecise (RR =4.74, 95% CI: 0.55-40.50).
CONCLUSIONS: In adults with severe pneumonia, combined FB-BAL and local drug injection improves clinical efficacy and shortens ICU stay. Antibiotics offer consistent benefits; expectorants provide greatest absolute gain in selected patients. Pediatric evidence is limited with safety concerns. Effect on mortality remains unclear. However, all 30 included trials were conducted in China, which may limit the generalizability of findings to other healthcare settings and populations. International validation studies are warranted.
METHODS: This study searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI) and Wanfang Data to collect randomized controlled trials (RCTs) published up to 10 May 2025 on the combined use of BAL and local drug injection in the treatment of patients with severe pneumonia. The primary outcome was clinical efficacy rate, with secondary outcomes including intensive care unit (ICU) length of stay, 28-day case fatality rate, and adverse events.
RESULTS: A total of 30 RCTs (2,742 patients) were included. Clinical efficacy rate: significantly improved in the combination therapy group [risk ratio (RR) =1.25, 95% confidence interval (CI): 1.19-1.31, P<0.001], with the greatest relative benefit observed in the middle-aged group (RR =1.33). Subgroup analysis by drug type showed that expectorants achieved the largest absolute improvement [absolute risk difference (ARD) 23.7%], while antibiotics demonstrated the most consistent efficacy. ICU length of stay: reduced by an average of 4.73 days (95% CI: -5.57 to -3.88, P<0.001). Safety: overall adverse events showed no difference (RR =2.13, 95% CI: 0.80-5.66). In the pediatric subgroup, based on two small studies (60 patients), the estimate was highly imprecise (RR =4.74, 95% CI: 0.55-40.50).
CONCLUSIONS: In adults with severe pneumonia, combined FB-BAL and local drug injection improves clinical efficacy and shortens ICU stay. Antibiotics offer consistent benefits; expectorants provide greatest absolute gain in selected patients. Pediatric evidence is limited with safety concerns. Effect on mortality remains unclear. However, all 30 included trials were conducted in China, which may limit the generalizability of findings to other healthcare settings and populations. International validation studies are warranted.