Quantitative assessment of epithelial lining fluid in the lung

Current techniques for the measurement lung epithelial fluid (ELF) volume depend on the dilution by a known volume of wash fluid (bronchoalveolar lavage) of a resident solute, such as urea, in the ELF or of a foreign solute introduced at known concentration in the lavage fluid. Knowledge of the ELF volume allows calculation of solute ELF concentrations. Urea concentration in ELF is assumed to be the same as in plasma. Although epithelial permeability to urea is low, entry of urea from tissues to lavage fluid occurs during the procedure and may lead to erroneous estimates of ELF volume as may loss of foreign solutes. Ideally, the extent of urea entry or of foreign solute loss should be estimated in each lavage. Other cautions are 1) equal osmolality of wash fluid and plasma, 2) minimizing residence time of wash fluid, 3) minimizing wash fluid-to-ELF volume ratio, and 4) adequate analytic procedures.