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Bronchoalveolar Lavage


Goals/Objectives

  • Indications

  • Anatomic considerations

  • Technical considerations

Bronchoalveolar Lavage and Protected Specimen Bronchial Brushing

Lillian L. Emlet

From Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink MP: Textbook of Critical Care, 6th edition (Saunders 2011)

Before Procedure

Indications

  • Diagnosis of pneumonia:

    • Viral, bacterial, fungal, mycobacterial, Pneumocystis carinii pneumonias

    • Quantitative cultures for ventilator-associated pneumonias

    • Infiltrates in an immunocompromised host

  • Evaluation of diffuse lung infiltrates

  • Suspected pulmonary hemorrhage

  • Suspected malignancies

  • Both bronchoalveolar lavage (BAL) and protected specimen bronchial brushing (PSB) use quantitative culture techniques to differentiate between airway colonization and true pulmonary infection.

Contraindications

  • Acute respiratory distress syndrome with hypoxemia

    • May cause de-recruitment of noncompliant severe air space disease

    • Watch for cardiac arrhythmias, hypoxemia, bronchospasm

  • Bronchopleural fistula

    • May not be able to return adequate specimen for analysis

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