title: Functional implications of BAL in the presence of restrictive or obstructive lung disease.
abstract: Most of the complications associated to bronchoscopy are related to changes of the respiratory function during or after its performance. Prevention of complications should be achieved by understanding the effects of bronchoscopic procedures and their relation to the pulmonary function deterioration. Previous studies regarding the functional impairment caused by bronchoalveolar lavage (BAL) were mostly limited by the presence of interferent factors such as sedative drugs. Furthermore, it is not clear whether or not patients with different ventilatory disturbances present the same functional response to bronchoscopy and BAL. The aim of this study was to determine the additional effects of BAL over the respiratory function deterioration related to bronchoscopy in patients with different respiratory function profiles (normal, restrictive and obstructive). Forty patients submitted to bronchoscopy without premedication were divided into four groups: group I-normal pulmonary function submitted to basic bronchoscopy; group II-bronchoscopy in combination with BAL, subdivided according to pulmonary function: group IIa (normal function), group IIb (restrictive ventilatory disturbances) and group IIc (obstructive ventilatory disturbances). Spirometry was made before and after the bronchoscopic procedure. Baseline hemoglobin saturation was compared to the lowest level during the procedure. Functional worsening caused by the procedure was observed with a decrease in forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)) and Hemoglobin saturation in all groups. Comparison between groups showed no significant difference regarding the changes in FVC (P=0.8324), FEV(1) (P=0.6952) and hemoglobin saturation (P=0.5044). We conclude that standardized BAL, like the one used in our study, does not result in an increased risk for ventilatory impairment compared to bronchoscopy itself, independently of the presence of previous respiratory disease.
authors.affiliation: Pulmonary Division, University of São Paulo Medical School, Rua Bagé 163 apto 182, São Paulo 04012-140, Brazil. wilson.pedreira@fleury.com.br
authors.forename: Wilson Leite
authors.initials: WL
authors.lastname: Pedreira
authors.forename: Rogério
authors.initials: R
authors.lastname: de Souza
authors.forename: Iara Nely
authors.initials: IN
authors.lastname: Fiks
authors.forename: João Marcos
authors.initials: JM
authors.lastname: Salge
authors.forename: Carlos Roberto Ribeiro
authors.initials: CR
authors.lastname: de Carvalho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018893:Bronchoalveolar Lavage / Q000009:adverse effects*; D001999:Bronchoscopy / Q000009:adverse effects; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000503:physiopathology*; D013147:Spirometry; D014797:Vital Capacity