• T T Bauer, A Torres, S Ewig, C Hernández, J M Sanchez-Nieto, A Xaubet, C Agustí, and R Rodriguez-Roisin.
• Medizinische Klinik und Poliklinik, Abt. Pneumologie, Allergologie und Schlafmedizin, Bergmannsheil, Klinikum der Ruhr-Universität, Bochum, Germany.
• Intensive Care Med. 2001 Feb 1;27(2):384-93.

ObjectiveTo assess the effect of bronchoalveolar lavage (BAL) volume on arterial oxygenation in critically ill patients with pneumonia.DesignRandomized clinical comparison.SettingSix-bed respiratory intensive care unit of a 850-bed tertiary care university hospital.PatientsThirty-seven intubated and mechanically ventilated patients with clinical suspicion of pneumonia.InterventionsBronchoscopically guided protected specimen brush (PSB) followed by either a "high volume" BAL (n = 16, protected catheter, mean volume: 131 +/- 14 ml) or a "low volume" BAL (n = 21, protected double-plugged catheter, 40 ml volume for all patients).MeasurementsArterial oxygen tension/fractional inspired oxygen (PaO2/FIO2) and mean arterial pressure (MAP) before and up to 24 h after the intervention. Bacterial growth in quantitative cultures. Analysis of variance for repeated measurements with inter-subject factors.ResultsAll patients showed a lower PaO2/FIO2 ratio and higher MAP after the diagnostic procedure, without differences between the study arms (p = 0.608 and p = 0.967, respectively). Patients with significant bacterial growth (p = 0.014) and patients without preemptive antibiotic (p = 0.042) therapy showed a more profound and longer decrease in arterial oxygenation after the diagnostic procedure.ConclusionsA decrease in the PaO2/FIO2 ratio was observed in all patients after a combined diagnostic procedure, independent of the BAL volume used. A significant bacterial burden recovered from the alveoli and no preemptive antibiotic therapy were associated with a larger and longer-lasting decrease in arterial oxygenation.

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