ABSTRACT
Respiratory samples obtained by bronchoalveolar lavage (BAL) in infectious processes
provide important microbiological and cytological information to manage this type
of patient. Most of the clinical and experimental BAL investigations have been done
in ventilator-associated pneumonia (VAP) and in immunosuppressed conditions. The impact
of quantitative BAL bacterial cultures for managing VAP is still controversial. However,
there is no doubt that this method provides sensitive and specific information on
bacterial, viral, fungal, and noninfectious etiologies. The conclusion is that BAL
has to be used in VAP depending on the clinical situation of the patient and taking
into account the local expertise and laboratory facilities. In immunosuppressed patients
with pulmonary infiltrates its utility has been clearly demonstrated. In this specific
population the early use of the information provided by this method is related to
a better outcome. In community-acquired pneumonia there is no strong information supporting
its use. This technique has some side effects and contraindications that have been
weighted individually in each patient.
KEYWORDS
Bronchoalveolar lavage - ventilator-associated pneumonia - immunosuppressed - pulmonary
infiltrates
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Antoni TorresM.D.
Servei de Pneumologia i Al·lèrgia Respiratòria, Hospital Clínic de Barcelona
C/ Villarroel, 170, 08036 Barcelona, Spain
eMail: atorres@ub.edu
