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Updated: Jan 20, 2026
Absorption of Nasal and Bronchial Fluids: Precision Sampling of the Human Respiratory Mucosa and Laboratory Processing of Samples
Published on: January 21, 2018
Non-directed bronchial lavage is a safe method for sampling the respiratory tract in critically ill patient
B V Bonvento1, J A Rooney2, M O Columb1
1Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Abstract:
Ventilated patients are at risk of acquiring ventilator-associated pneumonia. Various techniques are available for diagnosing ventilator-associated pneumonia including bronchoalveolar lavage, protected specimen brush and non-directed bronchoalveolar lavage. There is a paucity of evidence regarding the safety profile of these techniques, particularly non-directed bronchoalveolar lavage. This service evaluation aimed to establish whether non-directed bronchoalveolar lavage is a safe procedure. A prospective service evaluation of non-directed bronchoalveolar lavage on our adult intensive care unit was undertaken by a senior physiotherapist trained into carrying out the procedure, measuring pre- and post-procedure vital signs including heart rate (HR), tidal volume (VT), systolic blood pressure (SBP) and pulse oximetry (SpO2). Eighty-five episodes in 41 patients were included in the evaluation. There was a statistically significant difference between pre- and immediately post-procedure recordings for all vital signs measure. HR (min-1), means (SD) 87.1 (16.4), 91.5 (16.5), 87.5 (15.9), 87.7 (15.7) respectively pre, immediately, 5 min after and 30 min after procedure (P < 0.01). SBP mmHg, means (SD) 133.9 (26.1), 142.1 (25.6), 136.9 (25.3), 134.8 (23.4) pre, immediately, 5 min and 30 min after procedure (P < 0.01). VT mL, median (range) 0.523 (0.118-1.180), 0.512 (0.131-1.05), 0.519 (0.104-0.95), 0.534 (0.110-1.080) each pre, immediately, 5 min and 30 min post procedure (P < 0.05). SpO2 %, median (range) 98 (89-100), 100 (96-100), 98 (92-100), 97 (90-100) again each pre-, immediately post, 5 and 30 min post-procedure time-points (P < 0.0001). The statistically significant difference was not detected between pre-, 5 or 30 min post-procedure time-points. None of the changes observed were clinically significant and no untoward events happened to any of the subjects included. Non-directed bronchoalveolar lavage is a safe and inexpensive procedure that can be carried out easily in an intensive care setting by a trained physiotherapist, avoiding the need for invasive bronchoscopy.
Insights
Non-directed bronchoalveolar lavage is a safe and inexpensive procedure for diagnosing ventilator-associated pneumonia in intensive care units. This evaluation found no clinically significant adverse events, supporting its use by trained physiotherapists.
Area of Science:
- Critical Care Medicine
- Respiratory Therapy
- Infectious Disease Diagnostics
Background:
- Ventilator-associated pneumonia (VAP) is a significant risk for intubated patients.
- Diagnostic techniques for VAP include bronchoalveolar lavage (BAL), protected specimen brush (PSB), and non-directed bronchoalveolar lavage (ND-BAL).
- Limited evidence exists on the safety of these VAP diagnostic methods, especially ND-BAL.
Purpose of the Study:
- To evaluate the safety profile of non-directed bronchoalveolar lavage (ND-BAL) in an adult intensive care unit (ICU) setting.
- To determine if ND-BAL, performed by a trained physiotherapist, leads to clinically significant adverse events.
Main Methods:
- A prospective service evaluation was conducted on 85 ND-BAL procedures in 41 adult ICU patients.
- Vital signs, including heart rate (HR), tidal volume (VT), systolic blood pressure (SBP), and pulse oximetry (SpO2), were measured pre- and post-procedure.
- Data were analyzed for statistically significant changes and clinical significance.
Main Results:
- Statistically significant changes were observed in HR, SBP, VT, and SpO2 immediately post-procedure (P < 0.05 for all).
- No statistically significant differences were found between pre-procedure and 5- or 30-minute post-procedure measurements.
- No clinically significant changes or adverse events were recorded during the evaluation.
Conclusions:
- Non-directed bronchoalveolar lavage (ND-BAL) is a safe procedure when performed by a trained physiotherapist in the ICU.
- ND-BAL offers an inexpensive and accessible diagnostic method, potentially avoiding more invasive procedures like bronchoscopy.
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