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Related Experiment Videos

Comparison of two methods of diagnostic lung lavage in ventilated infants with lung disease.

P A Dargaville1, M South, P N McDougall

  • 1Department of Neonatology and University Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia. dargavip@cryptic.rch.unimelb.edu.au

American Journal of Respiratory and Critical Care Medicine
|September 3, 1999
PubMed
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Tracheal aspirate (TA) and nonbronchoscopic bronchoalveolar lavage (NB-BAL) are two methods for collecting lung lavage fluid in infants. While NB-BAL samples deeper in the lungs, TA fluid analysis may be equally valid for assessing pulmonary surfactant and lung dysfunction.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Physiology
  • Biomarker Analysis

Background:

  • Nonbronchoscopic lung lavage techniques for epithelial lining fluid (ELF) collection in intubated patients lack standardization and validation.
  • Infants with lung disease requiring ventilatory support necessitate reliable methods for pulmonary surfactant analysis.

Purpose of the Study:

  • To evaluate two small-volume saline lavage techniques (tracheal aspirate [TA] and nonbronchoscopic bronchoalveolar lavage [NB-BAL]) for collecting infant lung lavage fluid.
  • To compare the origin of return fluid, surfactant concentration estimates, and association with lung dysfunction for TA versus NB-BAL.

Main Methods:

  • Collected paired lung lavage fluid samples from 31 intubated infants using TA (4 x 0.5 ml saline) and NB-BAL (3 x 1 ml/kg).
  • Analyzed fluid for total protein, IgA secretory component (SC), and surfactant protein A (SP-A) concentrations.

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  • Assessed fluid origin, surfactant index agreement (Bland-Altman analysis), and prediction of lung dysfunction severity.

    • Main Results:

    • TA lavage yielded higher protein and SC concentrations and lower SP-A than NB-BAL, indicating a more proximal sampling site.
    • Mean SP-A concentrations differed significantly, but all surfactant indices showed poor agreement between TA and NB-BAL.
    • TA fluid estimates were equivalent to NB-BAL in predicting the severity of lung dysfunction.

    Conclusions:

    • NB-BAL provides fluid of more distal origin, but TA lavage may offer similar validity for estimating pulmonary surfactant indices.
    • Small-volume lung lavage techniques can be imprecise, and results should be interpreted cautiously.
    • TA lavage is a potentially valuable method for assessing pulmonary surfactant in critically ill infants.