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Bronchoalveolar Lavage (BAL) for Research; Obtaining Adequate Sample Yield
Published on: March 24, 2014
Flexible bronchoscopy and bronchoalveolar lavage in pediatric patients with lung disease
Ori Efrati1, Udi Sadeh-Gornik, Dalit Modan-Moses
1Pediatric Pulmonology Unit, Safra Children's Hospital, The Sheba Medical Center, Tel-Hashomer, Israel. ori.efrati@sheba.health.gov.il
Insights
Flexible bronchoscopy (FOB) with bronchoalveolar lavage (BAL) is a safe and effective diagnostic tool for critically ill children with airway abnormalities and pulmonary infiltrates. This procedure offers a high diagnostic yield, guiding crucial treatment decisions for improved patient outcomes.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Diagnostic Procedures
Background:
- Flexible bronchoscopy (FOB) and bronchoalveolar lavage (BAL) are essential for diagnosing pediatric airway and lung conditions.
- High-risk populations include immunocompromised, cancer patients (especially post-bone marrow transplant), and those with congenital heart disease (CHD).
Purpose of the Study:
- To evaluate the diagnostic rate, safety, and clinical utility of FOB in critically ill pediatric patients.
- To assess the impact of FOB on patient management and outcomes.
Main Methods:
- Retrospective chart review of 319 children undergoing 335 FOB procedures in a pediatric intensive care unit.
- Indications included infectious agent identification, airway evaluation, CHD, and trauma.
- Data collected from patient charts, bronchoscopy reports, and lab results.
Main Results:
- The overall diagnostic rate for FOB was 79%.
- FOB and BAL altered management in 23.9% of patients, with a higher yield in cancer/immune deficiency (38.7%) vs. CHD (20.4%) or pneumonia (17%).
- Major complications occurred in 2 patients; minor complications in 14%.
Conclusions:
- FOB and BAL play a vital role in evaluating pediatric airway abnormalities and pulmonary infiltrates.
- FOB should be considered an initial diagnostic tool for critically ill children requiring rapid, accurate diagnosis for survival.
Objective:
The use of flexible bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in investigating pediatric patient with airway abnormalities and pulmonary infiltrates are indispensable and are now a routine procedure in many centers. Immunocompromised and cancer patients, especially after bone marrow transplantation, and children who have undergone surgery for congenital heart disease (CHD) are at high risk for pulmonary disease. Our aim was to study the diagnostic rate, safety, and clinical yield of FOB in critically ill pediatric patients.
Design:
: Retrospective chart review.
Setting:
Pediatric intensive care unit in a tertiary university hospital.
Patients:
Three hundred nineteen children who underwent 335 FOB procedures. The indications for bronchoscopy included infectious agent identification in immune-competent patients with new pulmonary infiltrates seen on chest radiograph (46%) and in patients with fever and neutropenia with respiratory symptoms (18%), airway anatomy evaluation in patients with upper airway obstruction (16%), CHD (15%), and airway trauma (5%). Data were obtained by reviewing the patients' charts, bronchoscopy reports, and laboratory results.
Measurements And Main Results:
The diagnostic rate of FOB procedures was 79%. FOB and BAL resulted in alteration of management (positive clinical yield) in 70 patients (23.9%). A definite infectious organism was identified in 56 patients (17.6%). The clinical yield in patients with cancer or primary immune deficiency (38.7%) was significantly higher compared with patients with CHD (20.4%, p < 0.01) and pneumonia (17%, p < 0.01). Major complications were observed in two procedures (prolonged apnea), and minor complications (transient desaturation, stridor, and minor bleeding) were observed in 45 patients (14%).
Conclusions:
FOB and BAL have an important role in the evaluation of airway abnormality and pulmonary infiltrate in pediatric patients, in whom rapid and accurate diagnosis is crucial for survival. We suggest that FOB should be considered as an initial diagnostic tool in those critically ill patients.
