Clinical utility of bronchoalveolar lavage in immunocompromised hosts.

Bronchoalveolar lavage (BAL) has been used extensively for assessment of immunocompromised hosts with pulmonary infiltrates. Reported estimates of the diagnostic utility of BAL have varied because of differences in patient populations, diagnostic criteria, and study methods. Herein we report on the use of BAL to determine at least one of the final diagnoses in 150 immunocompromised patients. Although the frequency with which BAL provided at least one of the final diagnoses (overall diagnostic yield) was seemingly low (39%), the yield increased substantially when only patients with pathologically proven diagnoses were considered. The sensitivity of BAL was 82%, and the specificity was 53%. The use of rigid diagnostic criteria enabled us to distinguish pathogens from colonizers. Pneumocystis was considered a pathogen whenever it was identified. It was the most common infectious pathogen identified (50%) despite the fact that our study population had relatively few patients (only 4%) with acquired immunodeficiency syndrome (AIDS). Organisms such as cytomegalovirus, Aspergillus, and Candida were frequently identified in BAL specimens but were eventually proved to be pathogens in only 24%, 25%, and 0% of cases, respectively. BAL detected pulmonary malignant lesions on the basis of positive cytologic results in four of six patients eventually found to have primary or metastatic lung cancer. Our results should enhance the understanding of the strengths and weaknesses of BAL and assist in the interpretation of associated microbiologic findings.

[Value of bronchoalveolar lavage in the diagnosis and management of diffuse interstitial fibrosing lung diseases]. / Intérêt du lavage broncho-alvéolaire dans le diagnostic et la prise en charge des pneumopathies interstitielles diffuses fibrosantes.

Bronchoalveolar lavage (BAL) is an exploratory technique which is easy to perform and collect cellular constituents, notably inflammatory and immunocompetent cells, as well as biological elements that are present in the distal airways. In patient with chronic diffuse infiltrative lung disease, analysis of these parameters reveals various disturbances such as neutrophilia frequently associated with eosinophilia and, in some cases, lymphocytosis. These features are not specific, but they differentiate chronic diffuse infiltrative lung diseases from sarcoidosis and hypersensitivity lung diseases. Alveolar inflammation (alveolitis) correlates with the evolutive potential of the lesions and their ability to respond to treatment. The presence of lymphocytosis is usually associated with response to corticosteroid therapy, whereas the presence or persistence of neutrophilia and, even more, eosinophilia is characteristic of patients who do not respond to corticosteroids but are amenable to the cyclophosphamide-corticosteroid combination. BAL therefore increasingly appears as an irreplaceable tool to understand the physiopathology of chronic diffuse infiltrative lung diseases.

Bronchoscopy in intensive care.

Fiberoptic bronchoscopy has revolutionized the practice of modern pulmonary medicine. It is estimated that as many as 98% of all bronchoscopies are currently performed using the flexible instrument, and most bronchoscopists have never been trained in the technique of rigid bronchoscopy.

Bronchoalveolar lavage via a modified stomach tube in intubated patients with the acquired immunodeficiency syndrome and diffuse pneumonia.

A simple non-bronchoscopic bronchoalveolar lavage method was used in 30 patients with the acquired immunodeficiency syndrome undergoing assisted ventilation for respiratory failure. A modified Argyle Levin stomach tube was passed via the endotracheal tube and lavage performed. The lavage was well tolerated and performed quickly and easily, required little training, and had a high degree of sensitivity (73%--a diagnosis in 22 of the 30 cases).

Utility of bronchoalveolar lavage in the assessment of diffuse pulmonary infiltrates in nonAIDS immunocompromised patients.

The efficacy of bronchoscopy with bronchoalveolar lavage for diagnosing 32 episodes of diffuse pulmonary infiltrates was studied in 30 nonAIDS immunocompromised patients. Bronchoalveolar lavage had an overall diagnostic yield of 84% (27 of 32 episodes). Bronchoalveolar lavage was noncontributive in five episodes of pneumonitis: drug induced in one, nonspecific in three and pneumonitis of unestablished etiology in one. Overall, the procedure is safe and did not miss diagnoses for which conventional treatment was available. Our data support the use of bronchoscopy with bronchoalveolar lavage as the primary diagnostic procedure in immunocompromised patients with diffuse pulmonary infiltrates.