title: Effects of bronchoalveolar lavage volume on arterial oxygenation in mechanically ventilated patients with pneumonia.
abstract: OBJECTIVE
  To assess the effect of bronchoalveolar lavage (BAL) volume on arterial oxygenation in critically ill patients with pneumonia.
  
  
  METHODS
  Randomized clinical comparison.
  
  
  METHODS
  Six-bed respiratory intensive care unit of a 850-bed tertiary care university hospital.
  
  
  METHODS
  Thirty-seven intubated and mechanically ventilated patients with clinical suspicion of pneumonia.
  
  
  METHODS
  Bronchoscopically guided protected specimen brush (PSB) followed by either a "high volume" BAL (n = 16, protected catheter, mean volume: 131 +/- 14 ml) or a "low volume" BAL (n = 21, protected double-plugged catheter, 40 ml volume for all patients).
  
  
  METHODS
  Arterial oxygen tension/fractional inspired oxygen (PaO2/FIO2) and mean arterial pressure (MAP) before and up to 24 h after the intervention. Bacterial growth in quantitative cultures. Analysis of variance for repeated measurements with inter-subject factors.
  
  
  RESULTS
  All patients showed a lower PaO2/FIO2 ratio and higher MAP after the diagnostic procedure, without differences between the study arms (p = 0.608 and p = 0.967, respectively). Patients with significant bacterial growth (p = 0.014) and patients without preemptive antibiotic (p = 0.042) therapy showed a more profound and longer decrease in arterial oxygenation after the diagnostic procedure.
  
  
  CONCLUSIONS
  A decrease in the PaO2/FIO2 ratio was observed in all patients after a combined diagnostic procedure, independent of the BAL volume used. A significant bacterial burden recovered from the alveoli and no preemptive antibiotic therapy were associated with a larger and longer-lasting decrease in arterial oxygenation.
authors.affiliation: Medizinische Klinik und Poliklinik, Abt. Pneumologie, Allergologie und Schlafmedizin, Bergmannsheil, Klinikum der Ruhr-Universität, Bochum, Germany.
authors.forename: T T
authors.initials: TT
authors.lastname: Bauer
authors.forename: A
authors.initials: A
authors.lastname: Torres
authors.forename: S
authors.initials: S
authors.lastname: Ewig
authors.forename: C
authors.initials: C
authors.lastname: Hernández
authors.forename: J M
authors.initials: JM
authors.lastname: Sanchez-Nieto
authors.forename: A
authors.initials: A
authors.lastname: Xaubet
authors.forename: C
authors.initials: C
authors.lastname: Agustí
authors.forename: R
authors.initials: R
authors.lastname: Rodriguez-Roisin
mesh_terms: D000704:Analysis of Variance; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D018893:Bronchoalveolar Lavage / Q000009:adverse effects*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy / Q000009:adverse effects; D016009:Chi-Square Distribution; D005336:Fiber Optic Technology; D006801:Humans; D007362:Intensive Care Units; D010100:Oxygen / Q000097:blood*; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D012121:Respiration, Artificial / Q000009:adverse effects
chemical_list: D010100:Oxygen