The role of bronchoalveolar lavage in the diagnosis of bacterial pneumonia.

Bronchoalveolar lavage (BAL) has become an invaluable diagnostic tool with important clinical implications in both opportunistic infections and the pulmonary pathology of immunologic disease. Until recently, the use of BAL was limited primarily to two areas: the study of interstitial lung diseases and the diagnosis of lung infections by opportunistic microorganisms in severely immunocompromised patients with lung infiltrates. Over the past decade, the use of BAL has been expanded to include the conventional diagnosis of bacterial pneumonia in non-immunocompromised patients. In the past, different clinical studies proposed using BAL to quantify cultures in the sample obtained as a means of increasing the tool's effectiveness. Recent developments have led to a number of newer applications of BAL, such as bronchoscopic BAL, non-bronchoscopic BAL and protected BAL. The most important use of BAL in the non-immunocompromised patient is the diagnosis of pneumonia in the mechanically ventilated patient.

[Analysis of the bacteriologic data obtained with a double-lumen distally-plugged telescopic catheter in the diagnosis of pulmonary infiltrates in patients on low mechanical ventilation]. / Análisis de la información bacteriológica aportada mediante catéter telescopado de doble luz y oclusión distal en el diagnóstico de infiltrados pulmonares en pacientes bajo ventilación mecánica.

In order to assess the bacteriology of bronchial secretion samples, 40 patients in the intensive care unit who had developed fever and pulmonary infiltrates during mechanical ventilation have been studied. In each patient bronchial secretion samples were obtained by a double lumen distally-plugged telescopic catheter (DTC) inserted under direct view through the fiber bronchoscope (FB) as well as from simple bronchial aspiration (SBA) done simultaneously. A week later DTC and SBA were repeated. A statistically significant difference was found between the positive cultures obtained by SBA and those obtained by DTC (p less than 0.005). However, in 9 samples (14.27%) other microorganisms were isolated with DTC which were not detected by SBA and a lower number of colonizing microorganisms were found by DTC (p less than 0.05). The isolation of microorganisms by DTC allowed more precise management and moreover, a better clinical course was observed in those patients in whom chemotherapy was based on the data given by DTC. The relationship between the cultures obtained by DTC and the previous antibiotic treatment was statistically significant, finding a greater number of positive cultures when they were taken 2 hours after the last doses of the antibiotic. This relationship was not found in the cultures obtained with SBA. The most frequently isolated microorganisms were diverse types of Pseudomonas and Acinetobacter. No complication caused by the techniques arose.