A Comparison of Techniques for Optimal Performance of Bronchoalveolar Lavage

Background: Bronchoalveolar lavage (BAL) is a commonly used diagnostic and research tool. Currently, there is limited evidence regarding standardizing this technique. The type of suction method and number of aliquots used as well as the anatomic lung segment sampled are not standardized nor well studied. Our primary aim was to compare the quantity and quality of BAL specimens using 2 suction methods, hand-held syringe versus wall suction. Our secondary aim was to assess which anatomic lung segment yields the greatest BAL results and how many aliquots are required. Methods: A prospective clinical study was performed in patients undergoing bronchoscopies using hand-held syringe or wall suction. On the basis of radiologic findings, 100 mL (with 4 aliquots) of normal saline was instilled and the percentage volume return calculated. Results: Sixy-six patients were enrolled. Thirty-three patients received hand-held syringe and 33 using wall suction. There was no significant difference in the percentage volume returned, or the adequacy of fluid between these suction methods. When comparing volumes of return from different lobes, greater returns were demonstrated from the right middle lobe (P=0.002). In addition, with each sequential aliquot instilled, the return of fluid was increased significantly (P<0.001). Conclusions: No significant difference was observed between hand-held syringe and wall suction in terms of volumes returned and microbiological or diagnostic yield. Performance of BAL in the right middle lobe is associated with increased return and should be preferentially used when performing a nontargeted BAL in patients with diffuse computed tomography chest changes.