[Protected bronchoalveolar lavage: a new endoscopic method in the diagnosis of bacterial pneumonia].
BACKGROUND
The identification of causative microoganisms in severe pneumonias is a usually difficult problem. Protected brushing (PB) has a good specificity but a limited sensitivity. Conventional bronchoalveolar lavage (BAL-C) has an excellent sensitivity but a doubtful specificity. The investigation of a new technique such as the protected bronchoalveolar lavage (BAL-P) appears as logical, as it should combine the advantages of PB and BAL-C without their drawbacks.


METHODS
In 15 patients without bacterial or fungal infections and in 23 with bacterial or fungal pneumonia, quantitative cultures were carried out in the samples obtained with PB, BAL-P and BAL-C. PB and BAL-C were performed with the usual technique. BAL-P was performed through the internal catheter of a telescoped double catheter with reabsorbable distal cap within the fibroscope channel. 40 ml of saline were instillated for the lavage.


RESULTS
With BAL-P sensitivity was 95% and specificity 89%. These were, respectively, 55% and 94% with PB, and 95% and 42% with BAL-C. The technique of BAL-P was more complex an longer than that of PB.


CONCLUSIONS
If these results are confirmed in further studies, BAL-P might become a method of choice for the bacterial pneumonias where now PB is indicated. However, in patients with hypersecretion or when bronchoscopy should be rapidly carried out, PB is technically more feasible.
Castella
J
J
Servicio de Aparato Respiratorio, Hospital de la Santa Creu i Sant Pau, Barcelona.
Ausina
V
V
Puzo
C
C
Quintana
E
E
Rodríguez-Froján
G
G
Rello
J
J
Lunquin
M
M
García-Pachón
E
E
Belda
P
P
García-Barceló
M
M
D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy / Q000379:methods*; D006801:Humans; D009181:Mycoses / Q000150:complications / Q000175:diagnosis*; D011014:Pneumonia / Q000175:diagnosis* / Q000382:microbiology; D012680:Sensitivity and Specificity
Lavado broncoalveolar protegido: nuevo método endoscópico en el diagnóstico de las neumonías bacterianas.