Global InformationBronchoalveolar lavage information
| Bronchoalveolar lavage | |
|---|---|
| Pronunciation | /ˌbrɒŋkoʊˌælviˈoʊlər ləˈvɑːʒ/ BRONG-koh-AL-vee-OH-lər lə-VAHZH |
| Other names | Bronchoalveolar washing |
| ICD-9-CM | 33.24 |
| MeSH | D018893 |
Bronchoalveolar lavage (BAL), also known as bronchoalveolar washing, is a diagnostic method of the lower respiratory system in which a bronchoscope is passed through the mouth or nose into an appropriate airway in the lungs, with a measured amount of fluid introduced and then collected for examination. This method is typically performed to diagnose pathogenic infections of the lower respiratory airways[1][2][3] (leading to, for example pneumonia[4][5][6] and COVID-19[7][8]), though it also has been shown to have utility in diagnosing interstitial lung disease.[9] Bronchoalveolar lavage can be a more sensitive method of detection than nasal swabs in respiratory molecular diagnostics, as has been the case with SARS-CoV-2 where bronchoalveolar lavage samples detect copies of viral RNA after negative nasal swab testing.[10][11]
In particular, bronchoalveolar lavage is commonly used to diagnose infections in people with immune system problems,[12] pneumonia in people on ventilators,[5][6] and acute respiratory distress syndrome (ARDS).[3][13] It is the most common method used to sample the epithelial lining fluid (ELF) and to determine the protein composition of the pulmonary airways.[3][13]
BAL has even been used therapeutically to remove mucus (sputum), improve airway ventilation, and reduce airway inflammation in conditions such as chronic obstructive pulmonary disease (COPD)[14] and pediatric Mycoplasma pneumonia.[15] A much more intense version involving up to 50 liters of fluid is called whole lung lavage (WLL) and is used to treat pulmonary alveolar proteinosis (PAP).[16][17][18] When conditions disallow WLL, an endoscopic BAL can be used as a bridging procedure.[11]
- ^ Kahn, F.W.; Jones, J.M. (1987). "Diagnosing bacterial respiratory infection by bronchoalveolar lavage". Journal of Infectious Diseases. 155 (5): 826–9. doi:10.1093/infdis/155.5.862. PMID 3559290.
- ^ Sugeir, S.; de Moraes, A.G. (2019). "6. Bronchoscopy in the Intensive Care Unit". In Demetriades, D.; Inaba, K. (eds.). Atlas of Critical Care Procedures. Springer. p. 50. ISBN 9783319783673.
- ^ a b c Warriner, Z.; Lewis, M. (2019). "7. Bronchoalveolar Lavage". In Demetriades, D.; Inaba, K. (eds.). Atlas of Critical Care Procedures. Springer. pp. 57–62. ISBN 9783319783673.
- ^ Nieto, J.M.S.; Alcaraz, A.C. (1995). "The role of bronchoalveolar lavage in the diagnosis of bacterial pneumonia". European Journal of Clinical Microbiology and Infectious Diseases. 14 (10): 839–50. doi:10.1007/BF01691489. PMC 7102128. PMID 8605896.
- ^ a b Jonker, M.A.; Sauerhammer, T.M.; Faucher, L.D.; et al. (2012). "Bilateral versus unilateral bronchoalveolar lavage for the diagnosis of ventilator-associated pneumonia". Surgical Infections. 13 (6): 391–5. doi:10.1089/sur.2011.081. PMC 3532003. PMID 23240724.
- ^ a b Yang, X.J.; Wang, Y.B.; Zhou, Z.W.; et al. (2015). "High-throughput sequencing of 16S rDNA amplicons characterizes bacterial composition in bronchoalveolar lavage fluid in patients with ventilator-associated pneumonia". Drug Design, Development and Therapy. 9: 4883–96. doi:10.2147/DDDT.S87634. PMC 4554422. PMID 26345636.
- ^ World Health Organization (19 March 2020). "Laboratory testing for coronavirus disease (COVID-19) in suspected human cases: Interim guidance, 19 March 2020". WHO/COVID-19/Laboratory/2020.5. World Health Organization. hdl:10665/331501. Retrieved 25 March 2020.
- ^ Centers for Disease Control and Prevention (25 March 2020). "Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19)". Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. Retrieved 25 March 2020.
- ^ Meyer, K.C.; Raghu, G.; Baughman, R.P.; et al. (2012). "An official American Thoracic Society clinical practice guideline: The clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease" (PDF). American Journal of Respiratory and Critical Care Medicine. 185 (9): 1004–14. doi:10.1164/rccm.201202-0320ST. PMID 22550210.
- ^ Ramos KJ, Kapnadak SG, Collins BF, Wall R, Bryson-Cahn C, Perchetti GA, Jerome KR, Khot S, Limaye AP, Mathias PC, Greninger AL (2020). "Detection of SARS-CoV-2 by bronchoalveolar lavage after negative nasopharyngeal testing: Stay vigilant for COVID-19". Respiratory Medicine Case Reports. 30: 101120. doi:10.1016/j.rmcr.2020.101120. PMC 7298516. PMID 32566476.
- ^ a b Rodrigo, D.; Rathnapala, A.; Senaratne, W. (2015). "Therapeutic limited bronchoalveolar lavage with fiberoptic bronchoscopy as a bridging procedure prior to total lung lavage in a patient with pulmonary alveolar proteinosis: A case report". Journal of Medical Case Reports. 9. 93. doi:10.1186/s13256-015-0574-z. PMC 4421915. PMID 25925248.
- ^ Henderson, A.J. (1994). "Bronchoalveolar lavage". Archives of Disease in Childhood. 70 (3): 167–9. doi:10.1136/adc.70.3.167. PMC 1029733. PMID 8135556.
- ^ a b Wang, Y.; Wang, H.; Zhang, C.; et al. (2019). "Lung fluid biomarkers for acute respiratory distress syndrome: A systematic review and meta-analysis". Critical Care. 23 (1). 43. doi:10.1186/s13054-019-2336-6. PMC 6373030. PMID 30755248.
- ^ Zhao, H.; Gu, H.; Liu, T.; Ge, J.; Shi, G. (2018). "Analysis of curative effect of adjuvant therapy with bronchoalveolar lavage on COPD patients complicated with pneumonia". Experimental and Therapeutic Medicine. 16 (5): 3799–3804. doi:10.3892/etm.2018.6662. PMC 6176127. PMID 30344655.
- ^ Wu, X; Lu, W; Wang, T; Xiao, A; Guo, X; Xu, Y; Li, S; Liu, X; Zeng, H; He, S; Zhang, X (5 October 2023). "Optimization strategy for the early timing of bronchoalveolar lavage treatment for children with severe mycoplasma pneumoniae pneumonia". BMC Infectious Diseases. 23 (1): 661. doi:10.1186/s12879-023-08619-9. PMC 10557288. PMID 37798699.
- ^ Michaud, G.; Reddy, C.; Ernst, A. (2009). "Whole-lung lavage for pulmonary alveolar proteinosis". Chest. 136 (6): 1678–1681. doi:10.1378/chest.09-2295. PMID 19995769.
- ^ Cleveland Clinic (6 August 2014). "How 'Lung Washing' Helps You Breathe Again". HealthEssentials. Archived from the original on 14 August 2020. Retrieved 25 March 2020.
- ^ Danel, C.; Israël-Biet, D.; Costabel, U.; Klech, H. (1992). "Therapeutic applications of bronchoalveolar lavage". European Respiratory Journal. 5 (10): 1173–5. doi:10.1183/09031936.93.05101173. PMID 1486961. S2CID 6265382.