Pediatric Bronchoalveolar Lavage: Practical Considerations and Future Prospects

Shell, Richard; Nicol, Kathleen

doi:10.2350/09-01-0591-pb.1

Cited by 5 publications

(5 citation statements)

References 68 publications

(91 reference statements)

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“…In this study, we used BAL neutrophils % of >15% or >20% as the gold standard marker of bronchitis. However, there is no consensus for definition of airway neutrophils percentage . The 20% cut off value used here could be viewed as arbitrary.…”

Section: Discussionmentioning

confidence: 99%

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Towards developing a valid scoring tool for bronchitis during flexible bronchoscopy

Thomas

McElrea

et al. 2018

Pediatric Pulmonology

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Background A valid bronchoscopic scoring tool for bronchitis would be useful for clinical and research purposes as currently there are none in children. From 100 digitally recorded flexible bronchoscopies (FB), we related the various macroscopic features to airway neutrophil % to develop a FB‐derived bronchitis score (BScoreexp). We aimed to develop a FB‐derived bronchitis tool. Methods FB recordings for six visualised features: secretions (amount and color) and mucosal appearance (erythema, pallor, ridging, oedema) based on pre‐determined criteria on a pictorial chart were assessed by two physicians independently, blinded to the clinical history. These features were used to obtain various models of BScoreexp that were plotted against bronchoalveolar lavage (BAL) neutrophil % using a receiver operating characteristic (ROC) curve. Inter‐ and intra‐rater agreement (weighted‐kappa, K) were assessed from 30 FBs. Results Using BAL neutrophilia of 20% to define inflammation, the highest area under ROC (aROC) of 0.71, 95%CI 0.61‐0.82 was obtained by the giving three times weightage to secretion amount and color and adding it to erythema and oedema. Inter‐rater K values for secretion amount (K = 0.87, 95%CI 0.73‐1.0) and color (K = 0.86, 95%CI 0.69‐1.0) were excellent. Respective intra‐rater K were 0.95 (0.87‐1.0) and 0.68 (0.47‐0.89). Other inter‐rater K ranged from 0.4 (erythema) to 0.64 (pallor). Conclusion A repeatable FB‐defined bronchitis scoring tool can be derived. However, a prospective study needs to be performed with larger numbers to further evaluate and validate these results.

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Section: Discussionmentioning

confidence: 99%

“…However, there is no consensus for definition of airway neutrophils percentage. 9,[21][22][23][24][25][26][27] The 20% cut off value used here could be viewed as arbitrary. However, patients with active bacterial infection rarely have <25% neutrophils 28,29 in their airways.…”

Section: Discussionmentioning

confidence: 99%

Towards developing a valid scoring tool for bronchitis during flexible bronchoscopy

Thomas

McElrea

et al. 2018

Pediatric Pulmonology

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“…Bronchoalveolar lavage (BAL) is a crucial part of an extended pediatric pulmonological diagnostic workup because it is the only way to obtain objectifiable parameters on the type and the extent of a bronchoalveolar inflammation (e.g., bronchial asthma) and the pathogens (e.g., protracted bacterial bronchitis). In the setting of suspected interstitial and alveolar processes, cytopathological examination of the BAL can exclude pathologies such as pulmonary alveolar proteinosis or provide further diagnostic information [11][12][13][14][15][16][17][18][19] (Table 1).…”

Section: Diagnostic and Therapeutic Bronchoalveolar Lavagementioning

confidence: 99%

Pediatric Airway Endoscopy: Recommendations of the Society for Pediatric Pneumology

et al. 2021

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For many decades, pediatric bronchoscopy has been an integral part of the diagnosis and treatment of acute and chronic pulmonary diseases in children. Rapid technical advances have continuously influenced the performance of the procedure. Over the years, the application of pediatric bronchoscopy has considerably expanded to a broad range of indications. In this comprehensive and up-to-date guideline, the Special Interest Group of the Society for Pediatric Pneumology reviewed the most recent literature on pediatric bronchoscopy and reached a consensus on a safe technical performance of the procedure.

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“…Bronchoalveolar lavage (BAL) has been used in children since the early 1970s, but it was not until 1995 that the European Respiratory Society set up a task force on pediatric BAL, 13 and although bronchoscopy is safe in experienced hands, it is an invasive procedure, and careful consideration of the risks and benefits in each case is essential 14 . BAL may increase the risk of hypoxemia and hypercapnia, and in rare cases, adverse effects such as pneumothorax, 15 pulmonary hemorrhage, and worsening of postoperative cough symptoms 14 .…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, in the treatment of SMPP, bronchoalveolar lavage (BAL) therapy can directly flush the diseased lung tissues, inject antibiotics and hormones, and remove inflammatory substances, so as to achieve the therapeutic purpose of unblocking the airways, resisting infection, and alleviating the condition. 12 Bronchoalveolar lavage (BAL) has been used in children since the early 1970s, but it was not until 1995 that the European Respiratory Society set up a task force on pediatric BAL, 13 and although bronchoscopy is safe in experienced hands, it is an invasive procedure, and careful consideration of the risks and benefits in each case is essential. 14 BAL may increase the risk of hypoxemia and hypercapnia, and in rare cases, adverse effects such as pneumothorax, 15 pulmonary hemorrhage, and worsening of postoperative cough symptoms.…”

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confidence: 99%

Quantitative evaluation of bronchoalveolar lavage for the treatment of severeMycoplasma pneumoniaepneumonia in children—A new complementary index: Bronchial Insufflation Sign Score

Gao,

Wu,

Zhang

et al. 2024

J of Clinical Ultrasound

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ObjectiveThe aim of this study was to investigate the value of Broncoplasma Insufflation Sign in lung ultrasound signs in assessing the efficacy of bronchoalveolar lavage in Severe mycoplasma pneumoniae pneumonia in children.MethodsForty‐seven children with Severe mycoplasma pneumoniae pneumonia were treated with medication and bronchial lavage. Laboratory and imaging results were collected, and lung ultrasonography was performed before bronchoalveolar lavage and 1, 3, and 7 days after lavage to record changes in Bronchial Insufflation Sign and changes in the extent of solid lung lesions. Factors affecting the effectiveness of bronchoalveolar lavage were analyzed using logistic regression and other factors.ResultsBronchial Insufflation Sign Score and the extent of lung solid lesions were the factors affecting the effectiveness of bronchoalveolar lavage treatment. The smaller the area of lung solid lesions and the higher the Bronchial Insufflation Sign Score, the more effective the results of bronchoalveolar lavage treatment were, and the difference was statistically significant, with a difference of p < 0.05. The Bronchial Insufflation Sign Score had the highest sensitivity and specificity for the prediction of the efficacy of bronchoalveolar lavage treatment in the first 7 days after the treatment.ConclusionBronchial Insufflation Sign Score combined with the extent of solid lung lesions can assess the efficacy of bronchoalveolar lavage in the treatment of Severe mycoplasma pneumoniae pneumonia in children; lung ultrasound is a timely and effective means of assessing the efficacy of bronchoalveolar lavage.

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Pediatric Bronchoalveolar Lavage: Practical Considerations and Future Prospects

Cited by 5 publications

References 68 publications

Towards developing a valid scoring tool for bronchitis during flexible bronchoscopy

Towards developing a valid scoring tool for bronchitis during flexible bronchoscopy

Pediatric Airway Endoscopy: Recommendations of the Society for Pediatric Pneumology

Quantitative evaluation of bronchoalveolar lavage for the treatment of severeMycoplasma pneumoniaepneumonia in children—A new complementary index: Bronchial Insufflation Sign Score

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