Chest
Volume 101, Issue 5, May 1992, Pages 1215-1220
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Bronchoalveolar Lavage in Immunocompromised Patients: Clinical and Functional Consequences

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Fiberoptic bronchoscopy and bronchoalveolar lavage are major tools in the diagnosis of acute pneumonia in immunocompromised patients. We conducted a prospective study to assess the morbidity associated with this procedure in 14 patients with AIDS and 16 patients with drug-induced immunosuppression. No patient had a PaO2 lower than 70 mm Hg with additional oxygen. Clinical data, chest roentgenogram, pulmonary function test, forced vital capacity, forced expiratory volume in one second, and arterial blood gases were recorded before and after bronchoscopy. Arterial oxygen saturation was monitored during the procedure, and initial, lowest, and final saturation values were noted. The patients were separated into three groups on the basis of chest roentgenographic findings. No procedure-induced pneumonia or need for tracheal intubation occurred. Minor clinical symptoms induced by the lavage in seven patients resolved spontaneously. By contrast, mean SaO2 decreased markedly during the procedure from 94 ±3 to 87 ±5 percent (p<0.0001) and returned to only 89 ±5 percent at the end of the procedure. Lowest SaO2 during the procedure and final SaO2 correlated poorly with initial SaO2 but correlated well with initial FVC and FEV1 (p<0.01). The PFT values were lower following bronchoscopy. O2 desaturation was more pronounced in patients with severe roentgenographic abnormalities. No significant differences were found between the three groups of patients, or between the AIDS and DII patients in terms of changes in PFT values. We conclude that in immunocompromised patients, bronchoscopy with BAL induces severe arterial oxygen desaturation which is correlated with initial PFT and chest roentgenographic findings, and most of these abnormalities are transient and do not lead to major complications.

Section snippets

MATERIALS AND METHODS

The study design was approved by the Ethics Committee of our institution and informed consent was obtained from all the patients.

RESULTS

The procedure was well tolerated by all the patients; it lasted 12 ± 14 min and the lavage required 2.9 ±0.8 min. A mean of 79 ±26 ml (range: 47 to 144 ml) of the 200 ml of saline solution instilled was retained in the lung (39.5 percent). No significant difference was found between the groups.

DISCUSSION

In this small sample of patients, BAL was associated with marked but transient desaturation. However, in contrast to the report by Martin et al,11 none of our patients required mechanical ventilation after bronchoscopy.

Bronchoscopy and lavage induced a significant drop in SaO2. Several authors have studied changes in arterial blood gases during fiberoscopy with saline solution lobar lavage,14, 15, 16 although none used pulse oximetry. Burns et al14 performed repeated arterial blood gas

ACKNOWLEDGMENT

The authors thank F. Delcampe, C. Tetard, and E. Benacquista for the preparation of the manuscript.

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