Clinical Significance of Bronchoalveolar Lavage in Severely Burned Patients with Diffuse Lung Infiltrations

ABSTRACT

PURPOSE: Pulmonary infiltrates are often encountered in mechanically ventilated burned patients and represent a challenge for pulmonologists and burn intensivists. The etiology is often multiple and empiric therapy is frequently initiated on the basis of clinical diagnosis, which is of uncertain accuracy. This approach can lead to inadequate treatment with increasing the risks of possible adverse events, while potentially reversible causes may be unrecognized. We performed bronchoalveolar lavage (BAL) study to know the causes of lung infiltration in severely burned patients. METHODS: From August 2003 to August 2008, severely burned patients who have been managed in burn intensive care unit (ICU) and shown diffuse lung infiltration during the courses were included prospectively. BAL was used to make the diagnosis of the respiratory infection, with 104> or = organisms considered a positive result. We also analyzed BAL isolates such as fungus, atypical pathogens and virus. RESULTS: Total 50 patients (M 43, F 7) were enrolled. The percent of total body surface area burn was 48.1+/-19.0% and APACHE II score was 10.0+/-5.6. Overall mortality was 64% (32 cases). 44 cases (88%) met criteria for positive BAL culture and 12 cases (24%) of those were combined with alveolar hemorrhage. The frequent bacterial isolates were Acinetobacter species in 19 cases (38%), Pseudomonas aeruginosa in 18 cases (36%) and methicillin-resistant Staphylococcus aureus in 14 cases (28%). Through BAL study, respiratory viruses were isolated in 15 cases (30%), and Legionella pneumonia, Tuberculosis and Pneumocystis pneumonia were reported in one of each (2%). CONCLUSION: BAL seems to be a useful tool for identifying infectious pathogens and may give guidance for adequate choices of antimicrobial agents in severely burned patients with diffuse lung infiltrations.