Clinical evaluation of bronchopulmonary lavage using the flexible fiberoptic bronchoscope

Thirty-three patients had segmental and lobar bronchopulmonary lavage using three types of flexible fiberoptic bronchoscopes. A maximum volume of 300 ml of normal saline solution at room temperature was used. Lavage was effective for removing large numbers of alveolar macrophages (mean, 17 million) and proteinaceous material (mean, 0.18 mg per milliliter) that helped enhance the antibacterial properties of the macrophages. Transient shunting (mean fall in partial pressure of arterial oxygen, 65 mm Hg) and alveolar filling that reverted to normal in 3 hours were noted. The procedure averaged 45 minutes and was as simple as bronchoscopy. The larger the internal diameter of the bronchoscope (> 2.6 mm) the better suited it was for lavage. Sequential segmental lavage seems to offer the advantages of simplicity and technical ease over isolated lobar lavage with a balloon-tipped bronchoscope. It also has the advantage of simplicity over whole-lung lavage.