title: A Prospective Randomized Study Comparing Manual and Wall Suction in the Performance of Bronchoalveolar Lavage.
abstract: BACKGROUND
  Bronchoalveolar lavage (BAL) may be performed using a hand-held syringe or wall suction.
  
  
  OBJECTIVE
  The aim was to study BAL volume and diagnostic yields based on BAL technique.
  
  
  METHODS
  A total of 220 consecutive patients undergoing BAL at our center were included. Manual aspiration was performed in 115 patients (group 1), and wall suction (<50 mm Hg of negative pressure) was used in 105 patients (group 2). All bronchoscopies were performed under conscious sedation applying topical anesthesia with lidocaine. Three 50-ml sterile saline aliquots were instilled in all patients.
  
  
  RESULTS
  The mean total amount of fluid recovered was 67 ± 20 ml in group 1 and 55 ± 22 ml in group 2 (p < 0.001). More patients in the manual aspiration group met American Thoracic Society criteria (recovery of ≥30% of instilled fluid) for an optimal BAL (81 vs. 59%; p < 0.001). The quantity of recovered fluid was also related to BAL location (p < 0.001) and radiologic findings (p = 0.002). Forty-eight (22%) BALs were diagnostic (23 in group 1 and 25 in group 2), including 37 positive bacterial cultures, 6 positive stains for Pneumocystis, and 5 cases of malignancy. No statistically significant difference in diagnostic yield was observed between the two groups. A BAL diagnosis was more likely in patients with certain radiologic (p = 0.033) and endoscopic findings (p = 0.001). When taking into account all bronchoscopic techniques performed during the procedure (e.g. biopsies, brushing, etc.), bronchoscopy was diagnostic in 37% of patients.
  
  
  CONCLUSIONS
  Manual aspiration is superior to wall suction during BAL yielding a larger quantity of aspirate. Diagnostic yields are similar for both techniques.
authors.affiliation: Pulmonary Department, Instituto de Investigacix00F3;n Sanitaria (IIS) - Fundacix00F3;n Jimenez Dx00ED;az University Hospital, CIBERES, Madrid, Spain.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Seijo
authors.forename: Javier
authors.initials: J
authors.lastname: Flandes
authors.forename: Maria V
authors.initials: MV
authors.lastname: Somiedo
authors.forename: Alba
authors.initials: A
authors.lastname: Naya
authors.forename: Josefina
authors.initials: J
authors.lastname: Manjón
authors.forename: Susana
authors.initials: S
authors.lastname: Álvarez
authors.forename: Iker
authors.initials: I
authors.lastname: Fernández-Navamuel
mesh_terms: D000368:Aged; D018893:Bronchoalveolar Lavage / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D001999:Bronchoscopy / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies