Clinical utility of bronchoalveolar lavage in a general hospital

Although bronchoalveolar lavage (BAL) performed through a fiberoptic bronchoscope is a valuable research tool, its clinical utility has been established in only two specific populations-the acquired immunodeficiency syndrome and immunosuppressed hosts with diffuse pulmonary infiltrates. We questioned whether BAL would be helpful in decision making in a general hospital setting. Eighteen patients, none of whom had the combination of immunosuppression and diffuse roentgenographic infiltrates and none of whom had acquired immunodeficiency syndrome, underwent BAL without any complications. The BAL fluid was analyzed in a hospital clinical laboratory using only stains that are generally used for bronchial washings. Retrospective analysis showed that in 9 cases (50%), the BAL analysis resulted in a significant alteration of therapy that would not have occurred using bronchial washings alone. Therefore, it appears that BAL can be safely performed in a general hospital on various patient populations, and that analysis in a nonresearch laboratory can yield clinically useful results.