Arterial Oxygen Desaturation as a Consequence of Different Bronchoalveolar Lavage Techniques

Abstract

To assess the influence of bronchoalveolar lavage (BAL) on oxygenation status, 45 subjects (36 men, 9 women; mean age. 64.4 ± 7.2 years) suffering from chronic obstructive pulmonary disease (COPD) underwent flexible bronchoscopy (FFB) as a diagnostic procedure. Thirty of them also underwent BAL to complete the investigation. This second group of patients was. further, divided into two subgroups (of 15 each) in which BALs were performed with the patient in the supine position by infusing, respectively, five aliquots of 20 ml each and two aliquots of 50 ml each of sterile saline solution at 37°C into a subsegmentary branch of both the right middle lobe and the lingula. All patients were connected to a pulse oximeter for the duration of the investigation and had an arterial blood gas (ABG) analysis immediately before the initiation of FFB and within 5 min of cessation of the bronchoscopic procedure. A significant change in arterial oxygen pressure was observed as a consequence of FFB itself (79.2 ± 4.2 vs 64.4 ± 3.8 mm Hg; p < 0.02). The negative influence of BAL on arterial oxygenation was greater, especially in those patients in whom BAL was performed with two aliquots of 50 ml each (77.0 ± 3.4 vs 59.8 ± 3.0 mm Hg; p < 0.005) rather than in those in whom BAL was done with five aliquots of 20 ml each (77.3 ± 4.0 vs. 63.2 ± 3.1 mm Hg; p < 0.01). Oxygen saturation did not differ significantly until the second pulmonary site was investigated (96.3 ± 5.6 vs 88.3 ± 3.9 and 95.8 ± 4.2 vs 87.1 ± 3.7%, respectively, for the two BAL patient groups; p < 0.005). In conclusion, our data suggest that, besides any consideration regarding practical consequences that different techniques unequivocally offer, in patients suffering from COPD, BAL must be performed with the infusion of small aliquots of fluid to protect patients from severe arterial deoxygenation.