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Bronchoalveolar Lavage BAL for Research; Obtaining Adequate Sample Yield
Published on: March 24, 2014
Effects of different bronchoalveolar lavage methods on tracheobronchial foreign body patients
Hua-Nan Luo1, Si-Jing Ma1, Hai-Li Guo1
1Department of Otolaryngology-Head and Neck Surgery, The Second Hospital, Xi'an Jiaotong University, Xi'an, China.
Insights
Bronchoalveolar lavage (BAL) with lidocaine, epinephrine, and dexamethasone significantly reduced complications in pediatric patients with inhaled tracheobronchial foreign bodies (TFB). This treatment also accelerated patient recovery compared to saline or no lavage.
Area of Science:
- Pediatric Pulmonology
- Anesthesiology
- Critical Care Medicine
Background:
- Inhaled tracheobronchial foreign bodies (TFB) pose a significant risk in pediatric patients.
- Bronchoalveolar lavage (BAL) is a procedure used in TFB management.
- Optimizing BAL solutions may improve patient outcomes.
Purpose of the Study:
- To compare the efficacy of different bronchoalveolar lavage (BAL) solutions.
- To evaluate the impact of lidocaine, epinephrine, and dexamethasone combinations in pediatric TFB cases.
- To assess the influence on intraoperative/postoperative complications and recovery.
Main Methods:
- Randomized controlled study involving 240 pediatric patients with TFB.
- Four groups: saline (S), lidocaine-epinephrine (LE), lidocaine-epinephrine-dexamethasone (LED), and control (C).
- Evaluation of complication rates, recovery periods, and inflammatory cytokine levels (IL-1β, IL-6, TNF-α).
Main Results:
- The LED group showed significantly lower incidences of bronchospasm, hypoxemia, and fever.
- Recovery and healing periods were shorter in the LE and LED groups compared to C and S groups.
- Inflammatory cytokine levels (IL-1β, IL-6, TNF-α) in BAL fluid were elevated in LE and LED groups.
Conclusions:
- Bronchoalveolar lavage (BAL) with lidocaine, epinephrine, and dexamethasone is effective in pediatric TFB management.
- This combination therapy reduces complications and accelerates recovery.
- The mechanism may involve the regulation of pro-inflammatory cytokine release.
Objectives/Hypothesis:
To compare the different effects of bronchoalveolar lavage (BAL) with diverse combinations of lidocaine, epinephrine, and dexamethasone on pediatric patients with an inhaled tracheobronchial foreign body (TFB).
Study Design:
Randomized controlled study.
Methods:
Two hundred forty cases of pediatric patients with inhaled TFB were included in this study, and were randomly divided into four groups using three kinds of drugs for BAL, namely 0.9% saline (S) group, 2% lidocaine with diluted epinephrine (LE) group, 2% lidocaine with diluted epinephrine and 0.5% dexamethasone (LED), control group (C) without BAL. The incidences of intraoperative or postoperative complications and recovery periods were compared. Meanwhile, the concentrations of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α in BAL fluids and plasma were evaluated by enzyme-linked immunosorbent assay.
Results:
The incidences of bronchospasm, hypoxemia, and postoperative fever were significantly lower in the LED group than other groups (P < .001). Fever after the TFB removal procedure appeared later in the LED group than the other groups. The improvement and healing periods in the LE and LED groups were significantly shorter than those in the C and S groups (P < .001). The concentrations of IL-1β, IL-6, and TNF-α in BAL fluids were significantly higher in the LE and LED groups than those in the S group (P < .001), but those in the plasma of the C and S groups were lower compared with the LE and LED groups (P < .001).
Conclusions:
BAL with lidocaine, epinephrine, and dexamethasone could promote recovery for TFB patients and reduce incidences of complications, possibly by regulating release of proinflammatory cytokines.
Level Of Evidence:
1b.
