Role of nonbronchoscopic lavage for investigating alveolar inflammation and permeability in acute respiratory distress syndrome.
OBJECTIVE
Nonbronchoscopic bronchoalveolar lavage is often used as an alternative to bronchoscopic bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia. We have previously reported an improved safety profile for nonbronchoscopic lavage in patients with lung injury, suggesting that this may be a better technique in this patient group. The objective of this study was to determine whether nonbronchoscopic lavage could be used as an alternative to bronchoscopic lavage for the assessment of alveolar permeability and inflammation in patients at risk for acute respiratory distress syndrome (ARDS) or with ARDS.


METHODS
Prospective randomized crossover trial.


METHODS
Intubated patients with ARDS or at risk of ARDS.


METHODS
Bronchoscopic and nonbronchoscopic lavage in the same patient, 15 mins apart.


RESULTS
Twenty-one patients with ARDS and 20 patients at risk of ARDS were recruited and underwent nonbronchoscopic and bronchoscopic lavage in randomized order. Despite similar volumes of lavage fluid, nonbronchoscopic lavage had fewer cells and an increased ratio of bronchial epithelial cells to macrophages. Although average concentrations of myeloperoxidase and total protein, the protein permeability index, and the epithelial-lining fluid volume were similar with the two techniques and demonstrated moderate linear associations, Bland and Altman analysis revealed poor comparability, with substantial side-to-side variability and wide 95% limits of agreement. Furthermore, unlike bronchoscopic lavage, nonbronchoscopic lavage was unable to differentiate between patients with ARDS and those at risk of ARDS.


CONCLUSIONS
Nonbronchoscopic lavage is not comparable to bronchoscopic lavage and as such cannot be used as an alternative to bronchoscopic lavage for assessing alveolar inflammation in patients with ARDS.
Perkins
Gavin D
GD
Intensive Care Unit, Birmingham Heartlands Hospital, Birmingham, UK.
Chatterjie
Somnath
S
McAuley
Danny F
DF
Gao
Fang
F
Thickett
David R
DR
D000328:Adult; D018893:Bronchoalveolar Lavage / Q000379:methods; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D001999:Bronchoscopy / Q000379:methods*; D016001:Confidence Intervals; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010539:Permeability; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology; D011336:Probability; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000628:therapy; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index