Role of Bronchoalveolar Lavage in Hospitalized Pediatric Patients

Abstract

Bronchoalveolar lavage (BAL) has been shown to be a rapid, relatively safe, and relatively noninvasive diagnostic procedure. Theoretically, BAL can be performed on all children hospitalized for pneumonia resistant to oral antibiotics, though practically and economically, this is not feasible. A 1-year retrospective review was conducted to define a cost-effective role for BAL in the management of hospitalized children with resistant pneumonia. The data revealed identification of at least one pathogen in 87% of sputum samples and in 95% of BAL specimens. Sputum samples provided the same information as the more invasive BAL technique in 60% of patients who had both sputum and BAL obtained for culture. Recommendations are made for the use of BAL as a diagnostic tool in the hospitalized child with resistant pneumonia.

Perfluorodecalin lavage of a longstanding lung atelectasis in a child with spinal muscle atrophy

“…On day 17, after 1 week without improvement, we decided with the parents consent to try PFC lavage with Perfluorodecalin HP (F2 Chemicals, Preston, Lancashire, UK). PFC was chosen because of its physical properties; low surface tension, high solubility for both oxygen and carbon dioxide and has been shown to be safe as a lavage agent, even in severe respiratory failure 12, 14…”

“…Children with neuromuscular disease are at high risk of this complication 1–3. There are several treatment options: chest physiotherapy3–6; positive end expiratory pressure (PEEP) with a mask; pressure increases on the ventilator7; inhalation of β2 agonists8; selective suction of the bronchi guided by bronchoscopy9–11; and bronchioalveolar lavage (BAL) 12–15. Such lavage has been performed with different agents including normal saline, N ‐acetylcysteine and diluted surfactant 11, 16…”

Assisted cough devices

“…Bronchoscopy has been used for the treatment of atelectasis, pulmonary alveolar proteinosis, intubation, and diagnosis and compared with PD & P 33,34 . It has been reported to deliver mucolytic therapy in ventilated, severe asthmatics 35 and help remove mucous plugs in this disease process.…”