Bronchoalveolar lavage to diagnose respiratory infections

Respiratory samples obtained by bronchoalveolar lavage (BAL) in infectious processes provide important microbiological and cytological information to manage this type of patient. Most of the clinical and experimental BAL investigations have been done in ventilator-associated pneumonia (VAP) and in immunosuppressed conditions. The impact of quantitative BAL bacterial cultures for managing VAP is still controversial. However, there is no doubt that this method provides sensitive and specific information on bacterial, viral, fungal, and noninfectious etiologies. The conclusion is that BAL has to be used in VAP depending on the clinical situation of the patient and taking into account the local expertise and laboratory facilities. In immunosuppressed patients with pulmonary infiltrates its utility has been clearly demonstrated. In this specific population the early use of the information provided by this method is related to a better outcome. In community-acquired pneumonia there is no strong information supporting its use. This technique has some side effects and contraindications that have been weighted individually in each patient.