title: Bronchoalveolar lavage (BAL) for research; obtaining adequate sample yield.
abstract: We describe a research technique for fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) using manual hand held suction in order to remove nonadherent cells and lung lining fluid from the mucosal surface. In research environments, BAL allows sampling of innate (lung macrophage), cellular (B- and T- cells), and humoral (immunoglobulin) responses within the lung. BAL is internationally accepted for research purposes and since 1999 the technique has been performed in > 1,000 subjects in the UK and Malawi by our group. Our technique uses gentle hand-held suction of instilled fluid; this is designed to maximize BAL volume returned and apply minimum shear force on ciliated epithelia in order to preserve the structure and function of cells within the BAL fluid and to preserve viability to facilitate the growth of cells in ex vivo culture. The research technique therefore uses a larger volume instillate (typically in the order of 200 ml) and employs manual suction to reduce cell damage. Patients are given local anesthetic, offered conscious sedation (midazolam), and tolerate the procedure well with minimal side effects. Verbal and written subject information improves tolerance and written informed consent is mandatory. Safety of the subject is paramount. Subjects are carefully selected using clear inclusion and exclusion criteria. This protocol includes a description of the potential risks, and the steps taken to mitigate them, a list of contraindications, pre- and post-procedure checks, as well as precise bronchoscopy and laboratory techniques.
authors.affiliation: Biomedical Research Centre in Microbial Diseases, National Institute for Health Research; Respiratory Infection Group, Royal Liverpool and Broadgreen University Hospital Trust; andrea.collins@liverpool.ac.uk.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Collins
authors.affiliation: Respiratory Infection Group, Liverpool School of Tropical Medicine.
authors.forename: Jamie
authors.initials: J
authors.lastname: Rylance
authors.affiliation: Institute of Infection and Global Health, University of Liverpool.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Wootton
authors.affiliation: Respiratory Infection Group, Liverpool School of Tropical Medicine; Comprehensive Local Research Network, Royal Liverpool and Broadgreen University Hospital Trust.
authors.forename: Angela D
authors.initials: AD
authors.lastname: Wright
authors.affiliation: Biomedical Research Centre in Microbial Diseases, National Institute for Health Research; Respiratory Infection Group, Liverpool School of Tropical Medicine.
authors.forename: Adam K A
authors.initials: AK
authors.lastname: Wright
authors.affiliation: Respiratory Infection Group, Liverpool School of Tropical Medicine; Department of Respiratory Research, University Hospital Aintree.
authors.forename: Duncan G
authors.initials: DG
authors.lastname: Fullerton
authors.affiliation: Respiratory Infection Group, Liverpool School of Tropical Medicine.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Gordon
mesh_terms: D018893:Bronchoalveolar Lavage / Q000295:instrumentation / Q000379:methods*; D005336:Fiber Optic Technology / Q000295:instrumentation / Q000379:methods; D006801:Humans