Abstract
Introduction: BAL may be performed using hand held siringe or wall suction. The Spanish Thoracic Society recommends manual suction following instillation of normal saline in a selected segmental bronchus. However, current clinical practice varies. We report on preliminary results from a randomized trial comparing BAL yields with both techniques.
Patients & Methods: 62 consecutive patients undergoing BAL at our center were included. Manual aspiration of instilled saline was performed with 50-cc syringe applied to the bronchoscope's suction valve, while aspiration using wall suction was performed with <50 mmHg of negative pressure applied using the suction trap connection. Premedication with intravenous midazolam and fentanyl, topical anesthesia with lidocaine and flexible bronchoscopes with working channel 2.8 mm were used. Microbiologic, immunologic and cytologic studies were performed.
Results: The mean total amount of fluid recovered by manual suction was 65.4 cc (+/-18.8), whereas 45.9 cc (+/-17) were obtained by wall suction (p=0.03). Nine BALs were diagnostic (6 manual and 3 wall suction) including 4 positive bacterial cultures, 3 positive stains for Pneumocystis and 2 cases of malignancy. When taking into account all techniques during the procedure, bronchoscopy was diagnostic in 25.8%. No complications or technical failures were recorded. This is an ongoing study; results regarding diagnostic yield should be available by early 2016.
Conclusions: Manual suction is superior to wall suction during BAL yielding a larger quantity of aspirate. Such findings may have implications for the diagnostic yield of this bronchoscopic technique.
- Copyright ©ERS 2015
