• Luis M Seijo, Javier Flandes, Maria V Somiedo, Alba Naya, Josefina Manjón, Susana Álvarez, and Iker Fernández-Navamuel.
• Pulmonary Department, Instituto de Investigacix00F3;n Sanitaria (IIS) - Fundacix00F3;n Jimenez Dx00ED;az University Hospital, CIBERES, Madrid, Spain.
• Respiration. 2016 Jan 1; 91 (6): 480-5.

BackgroundBronchoalveolar lavage (BAL) may be performed using a hand-held syringe or wall suction.ObjectivesThe aim was to study BAL volume and diagnostic yields based on BAL technique.MethodsA total of 220 consecutive patients undergoing BAL at our center were included. Manual aspiration was performed in 115 patients (group 1), and wall suction (<50 mm Hg of negative pressure) was used in 105 patients (group 2). All bronchoscopies were performed under conscious sedation applying topical anesthesia with lidocaine. Three 50-ml sterile saline aliquots were instilled in all patients.ResultsThe mean total amount of fluid recovered was 67 ± 20 ml in group 1 and 55 ± 22 ml in group 2 (p < 0.001). More patients in the manual aspiration group met American Thoracic Society criteria (recovery of ≥30% of instilled fluid) for an optimal BAL (81 vs. 59%; p < 0.001). The quantity of recovered fluid was also related to BAL location (p < 0.001) and radiologic findings (p = 0.002). Forty-eight (22%) BALs were diagnostic (23 in group 1 and 25 in group 2), including 37 positive bacterial cultures, 6 positive stains for Pneumocystis, and 5 cases of malignancy. No statistically significant difference in diagnostic yield was observed between the two groups. A BAL diagnosis was more likely in patients with certain radiologic (p = 0.033) and endoscopic findings (p = 0.001). When taking into account all bronchoscopic techniques performed during the procedure (e.g. biopsies, brushing, etc.), bronchoscopy was diagnostic in 37% of patients.ConclusionsManual aspiration is superior to wall suction during BAL yielding a larger quantity of aspirate. Diagnostic yields are similar for both techniques.© 2016 S. Karger AG, Basel.

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