Human Specimens - Indications for Bronchoalveolar Lavage

Human Specimens - Indications for Bronchoalveolar Lavage

(1) Respiratory failure, especially for those who cannot remove mucus plugs in bronchioles with cardiopulmonary resuscitation and conventional treatment. Weeinrlein performed 43 BAL treatments on 6 patients with mechanically ventilated respiratory failure. The indications are: ① Physical examination indicates poor ventilation or obvious bronchial obstruction; ② The usual method of suctioning bronchial secretions with negative pressure is ineffective; ③ The arterial partial pressure of oxygen decreases which cannot be relieved and shows intractable hypoxemia; ④ The thoracic compliance was significantly decreased, which was estimated to be caused by mucus embolism; ⑤ The chest X-ray showed pneumonia and atelectasis. After BAL, 63% (27/43) of patients had a significant improvement in compliance at 8 hours of treatment, and 81% (35/43) of patients had an improvement in PaO2 at 10-12 hours. The mean bronchial lavage volume was 237 plus or minus 6 mL of normal saline.

(2) Massive hemoptysis, after clearing airway secretions and embedded blood, the bleeding lesions can be lavaged with normal saline. Generally, 500 mL of normal saline at 4°C is used. Some people use cold diluted epinephrine to locally perfuse to control bleeding.

(3) Washing out harmful dust with saline in the early stage of pneumoconiosis can not only improve the symptoms but also change the prognosis. In recent years, there have been many reports on the study of large lung lavage for silicosis. For example, nearly 100 cases have been carried out in Nanjing in China, and the general response is good. The eluate of silicosis contains more than 100 mg of SiO2, which may play a preventive role in the development of long-term silicosis.

(4) Bronchiectasis with some refractory lower respiratory tract infections, and various antibiotics cannot control the amount of sputum. After lung lavage and local antibiotic instillation, 18 domestic reports have achieved good results. Complications, Rager integrated 82 patients with 240 BAL, only 1 died, the patient died of pulmonary embolism, whether it is related to BAL is not yet confirmed, and other patients had postoperative fever. It is generally believed that the selection of cases is appropriate, and BAL is still safe. Indication criteria are ① FEV1 greater than IL; ② PaO2 greater than 9.998kPa; ③ PaCO2 normal; ④ EKG normal; ⑤ No coagulation disorder. In conclusion, therapeutic BAI is a safe and effective method and a new therapeutic measure. Based on in-depth research on its indications, it is widely promoted and used, and it is believed that there will be new breakthroughs. The main purpose of the treatment of spontaneous pneumothorax is to choose an appropriate exhaust method according to the type of pneumothorax to relieve symptoms as soon as possible, so that lung recruitment; prevention and treatment of complications; prevention and reduction of recurrence. Exhaust treatment of pneumothorax includes thoracic aspiration therapy and intercostal intubation water-sealed bottle drainage, the latter is suitable for: tension pneumothorax, open pneumothorax or bilateral pneumothorax with poor lung function, closed pneumothorax after repeated aspiration Treatment of recurrent pneumothorax or lung can not be recruited. Where there are chronic lung diseases, lung atrophy greater than 20%, or pneumothorax exists for a long time, intercostal intubation should also be the first choice.