open access

Vol 87, No 1 (2019)
ORIGINAL PAPERS
Published online: 2019-03-04
Submitted: 2018-12-20
Accepted: 2019-02-05
Get Citation

Is it possible to predict, whether BAL salvage is going to be diagnostic?

Szymon Skoczyński, Ewelina Tobiczyk, Łukasz Minarowski, Marta Świerczyńska, Robert Mróz, Adam Barczyk
DOI: 10.5603/ARM.a2019.0004
·
Pubmed: 30830956
·
Adv Respir Med 2019;87(1):20-25.

open access

Vol 87, No 1 (2019)
ORIGINAL PAPERS
Published online: 2019-03-04
Submitted: 2018-12-20
Accepted: 2019-02-05

Abstract

Introduction: Bronchoalveolar lavage (BAL) is used in the diagnosis of interstitial lung diseases. BAL is diagnostic when ≥ 60%
of the instilled volume is recovered. There are no reliable markers useful to predict whether BAL volume is going to be diagnostic.
Our goal was to search for pulmonary function markers which could anticipate whether the recovered volume of instilled fluid
would be ≥ 60% of administered volume.

Material and methods: BAL volumes and quality were analyzed in the context of disease, medical condition and lung function
test results of the subjects hospitalized at the Pulmonology Ward from January 2015 to October 2016. The patients’ average age
was 61 (29–89).

Results: Among 80 procedures, diagnostic BAL (≥ 60%) has been obtained in 58 cases. The analysis of the group of patients with
an interstitial lung disease confirmed that there is a correlation between decreasing BAL recovered volume and an increase of
RV[%pred] (r = –0.34) and RV/TLC[%pred] (r = –0.41); p < 0.05. There was no significant correlation with DLCO. RV/TLC[%pred]
was the parameter with the highest predictive value for an anticipated correct BAL recovery. The curve analysis of the receiver
operating characteristic (ROC) showed a diagnostic accuracy (AUC 0.73, 95% CI 0.61–0.86).

Conclusions: Pulmonary hyperinflation may have a predictive role in anticipating a proper recovery of the BAL fluid volume.

Abstract

Introduction: Bronchoalveolar lavage (BAL) is used in the diagnosis of interstitial lung diseases. BAL is diagnostic when ≥ 60%
of the instilled volume is recovered. There are no reliable markers useful to predict whether BAL volume is going to be diagnostic.
Our goal was to search for pulmonary function markers which could anticipate whether the recovered volume of instilled fluid
would be ≥ 60% of administered volume.

Material and methods: BAL volumes and quality were analyzed in the context of disease, medical condition and lung function
test results of the subjects hospitalized at the Pulmonology Ward from January 2015 to October 2016. The patients’ average age
was 61 (29–89).

Results: Among 80 procedures, diagnostic BAL (≥ 60%) has been obtained in 58 cases. The analysis of the group of patients with
an interstitial lung disease confirmed that there is a correlation between decreasing BAL recovered volume and an increase of
RV[%pred] (r = –0.34) and RV/TLC[%pred] (r = –0.41); p < 0.05. There was no significant correlation with DLCO. RV/TLC[%pred]
was the parameter with the highest predictive value for an anticipated correct BAL recovery. The curve analysis of the receiver
operating characteristic (ROC) showed a diagnostic accuracy (AUC 0.73, 95% CI 0.61–0.86).

Conclusions: Pulmonary hyperinflation may have a predictive role in anticipating a proper recovery of the BAL fluid volume.

Get Citation

Keywords

interstitial lung diseases, bronchoalveolar lavage, spirometry, body pletysmography, DLCO

About this article
Title

Is it possible to predict, whether BAL salvage is going to be diagnostic?

Journal

Advances in Respiratory Medicine

Issue

Vol 87, No 1 (2019)

Pages

20-25

Published online

2019-03-04

DOI

10.5603/ARM.a2019.0004

Pubmed

30830956

Bibliographic record

Adv Respir Med 2019;87(1):20-25.

Keywords

interstitial lung diseases
bronchoalveolar lavage
spirometry
body pletysmography
DLCO

Authors

Szymon Skoczyński
Ewelina Tobiczyk
Łukasz Minarowski
Marta Świerczyńska
Robert Mróz
Adam Barczyk

References (19)
  1. King TE. Clinical advances in the diagnosis and therapy of the interstitial lung diseases. Am J Respir Crit Care Med. 2005; 172(3): 268–279.
  2. Stanowisko Komisji Chorób Układu Oddechowego Komitetu Patofizjologii Klinicznej Polskiej Akademii Nauk. Choroby śródmiąższowe płuc: Skala problemu — trudności diagnostyczne. Warszawa 2011.
  3. Meyer KC, Raghu G, Baughman RP, et al. American Thoracic Society Committee on BAL in Interstitial Lung Disease. An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. Am J Respir Crit Care Med. 2012; 185(9): 1004–1014.
  4. Gogali A, Wells A. Diagnostic approach to interstitial lung disease. Current Respiratory Care Reports. 2012; 1(4): 199–207.
  5. Ouellette DR. The safety of bronchoscopy in a pulmonary fellowship program. Chest. 2006; 130(4): 1185–1190.
  6. Chciałowski A, Chorostowska-Wynimko J, Fal A, et al. [Recommendation of the Polish Respiratory Society for bronchoalveolar lavage (BAL) sampling, processing and analysis methods]. Pneumonol Alergol Pol. 2011; 79(2): 75–89.
  7. Efared B, Ebang-Atsame G, Rabiou S, et al. The diagnostic value of the bronchoalveolar lavage in interstitial lung diseases. J Negat Results Biomed. 2017; 16(1): 4.
  8. Kebbe J, Abdo T. Interstitial lung disease: the diagnostic role of bronchoscopy. J Thorac Dis. 2017; 9(Suppl 10): S996–S99S1010.
  9. Collins AM, Rylance J, Wootton DG, et al. Bronchoalveolar lavage (BAL) for research; obtaining adequate sample yield. J Vis Exp. 2014(85).
  10. Haslam PL, Baughman RP. Report of ERS Task Force: guidelines for measurement of acellular components and standardization of BAL. Eur Respir J. 1999; 14(2): 245–248.
  11. Schildge J, Nagel C, Grun C. Bronchoalveolar lavage in interstitial lung diseases: does the recovery rate affect the results? Respiration. 2007; 74(5): 553–557.
  12. Olsen HH, Grunewald J, Tornling G, et al. Bronchoalveolar lavage results are independent of season, age, gender and collection site. PLoS One. 2012; 7(8): e43644.
  13. Löfdahl JM, Cederlund K, Nathell L, et al. Bronchoalveolar lavage in COPD: fluid recovery correlates with the degree of emphysema. Eur Respir J. 2005; 25(2): 275–281.
  14. Polish Society of Respiratory Diseases. The recommendations of the Polish Society of Respiratory Diseases on spirometry. Pneumonol Alergol Pol. 2006; 74(Suppl 1).
  15. Al-Qadi MO, Cartin-Ceba R, Kashyap R, et al. The Diagnostic Yield, Safety, and Impact of Flexible Bronchoscopy in Non-HIV Immunocompromised Critically Ill Patients in the Intensive Care Unit. Lung. 2018; 196(6): 729–736.
  16. Deotare U, Merman E, Pincus D, et al. The utility and safety of flexible bronchoscopy in critically ill acute leukemia patients: a retrospective cohort study. Can J Anaesth. 2018; 65(3): 272–279.
  17. Miguel-Reyes JL, Gochicoa-Rangel L, Pérez-Padilla R, et al. Functional respiratory assessment in interstitial lung disease. Rev Invest Clin. 2015; 67(1): 5–14.
  18. Seijo LM, Flandes J, Somiedo MV, et al. A Prospective Randomized Study Comparing Manual and Wall Suction in the Performance of Bronchoalveolar Lavage. Respiration. 2016; 91(6): 480–485.
  19. Skoczynski S, Wyskida K, Rzepka-Wrona P, et al. Novel method of noninvasive ventilation supported therapeutic lavage in pulmonary alveolar proteinosis proves to relieve dyspnea, normalize pulmonary function test results and recover exercise capacity: a short communication. J Thorac Dis. 2018; 10(4): 2467–2473.

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