RT Journal Article
SR Electronic
T1 Preliminary results from a prospective randomized trial comparing manual vs wall suction in the performance of bronchoalveolar lavage (BAL)
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA312
DO 10.1183/13993003.congress-2015.PA312
VO 46
IS suppl 59
A1 María del Valle Somiedo
A1 Luis Seijo
A1 Felipe Campo
A1 Iker Fernández-Navamuel
A1 Javier Flandes
YR 2015
UL http://erj.ersjournals.com/content/46/suppl_59/PA312.abstract
AB 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.