Tolerability of Broncho-Alveolar Lavage in Ventilated Patients with Acute Lung Injury

Broncho-alveolar lavage (BAL) is an important diagnostic tool in many areas of thoracic medicine. On the intensive care unit (ICU), BAL is often required for a variety of indications, including assessment of possible ventilator-associated pneumonia (VAP). Recent data suggest BAL may be superior to less invasive techniques in the assessment of VAP. Older studies have highlighted potential concerns over the safety of BAL in ICU patients but this has not been confirmed in more recent studies in patients with acute respiratory distress syndrome (ARDS). This prospective cohort study aimed to clarify the tolerability of BAL in 162 ventilated ICU patients with ARDS and possible VAP.

BAL was tolerated very well with only 2 patients (1.2%) demonstrating a mild desaturation (fall of 6% in oxygen saturation) due to 1 episode of bronchospasm and secretion retention respectively which were resolved quickly. No major complications or deaths occurred and BAL samples were obtained for microbial analysis in all patients. We conclude BAL is well tolerated in carefully selected and prepared ventilated ICU patients with ARDS in whom VAP is being considered. Further large scale controlled studies comparing BAL to less invasive techniques are indicated in this cohort.