TY - JOUR T1 - Indications of BAL, lung biopsy, or both in mechanically ventilated patients with unexplained infiltrations JF - European Respiratory Journal JO - Eur Respir J SP - 383 LP - 384 DO - 10.1183/09031936.03.00097702 VL - 21 IS - 3 AU - L. Papazian AU - M. Gainnier Y1 - 2003/03/01 UR - http://erj.ersjournals.com/content/21/3/383.abstract N2 - The diagnosis of unexplained infiltrations in mechanically ventilated patients is a major problem in intensive care unit (ICU) patients. In this issue of the European Respiratory Journal, Bulpa et al. 1 report the results of 38 mechanically ventilated patients who underwent bronchoalveolar lavage (BAL) combined with transbronchial biopsy (TBB) for the diagnosis of lung infiltrates. They obtained a diagnosis in 74% of the patients, which altered the treatment in 63% of the patients. The diagnostic performance was equally effective in both immunocompetent and immunosuppressed patients. BAL is a firstline examination with many advantages, including a large sampled lung area and sufficient fluid return to perform multiple analyses. Indeed, cytology (percentage of neutrophils, siderophages, eosinophils and presence of malignant cells), a Gram stain, and numerous cultures (bacteriology, mycology, virology) can be performed. BAL is one of the best tools to establish the diagnosis of bacterial ventilator-associated pneumonia. BAL was evaluated in mechanically ventilated patients by Aubas et al. 2, who found a sensitivity of 89% and a specificity of 83% when using clinical and radiological criteria. When compared with histological criteria, at a threshold of 104 colony forming units (cfu)·mL−1, BAL exhibited a sensitivity of 47–58% 3–5. Its sensitivity can reach 91% in patients not receiving antibiotics 6. The specificity of BAL varies from 45–100% when compared with histological examination 3–6. When diffuse infiltrates are present, a definite diagnosis can be difficult to establish, especially in acute respiratory distress syndrome (ARDS) patients. Therefore, histological diagnosis could be useful when BAL does not contribute to the diagnosis in the following two … ER -