Bronchoalveolar lavage in children. ERS Task Force on bronchoalveolar lavage in children. European Respiratory Society

Blic, J. de; Midulla, Fabio; Barbato, Angelo; Clément, Alexandra; Dab, I.; Eber, Ernst; Green, C; Grigg, Jonathan; Kotecha, Sailesh; Kurland, Geoffrey; Pohunek, Petr; Ratjen, Félix; Rossi, G

doi:10.1183/09031936.00.15121700

Cited by 352 publications

(75 citation statements)

References 75 publications

(122 reference statements)

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“…[9] The 2 nd and 3 rd aliquots are pooled for cytology and non-cellular studies as they are more distal samples. When undertaking single aliquot bronchial washings it is not therefore appropriate to send cytology studies.…”

Section: Discussionmentioning

confidence: 99%

“…This differs from the European Respiratory Society (ERS) guidance which recommends a triple aliquot sample from a single lobe. [9] Our practice is based on the knowledge that this methodology is safe and has been used to demonstrate a heterogeneous distribution of bacteria in the lungs of children with other respiratory conditions, such as cystic fibrosis (CF). [10] The aim of this study was to review the FB-BAL and CXR results in children with PBB, to assess the bacterial distribution across lung lobes in children with PBB.…”

Section: Introductionmentioning

confidence: 99%

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Bacterial Distribution in the Lungs of Children with Protracted Bacterial Bronchitis

et al. 2014

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ObjectivesFlexible bronchoscopy with bronchoalveolar lavage (FB-BAL) is increasingly used for the microbiological confirmation of protracted bacterial bronchitis (PBB) in children with a chronic wet cough. At our centre, when performing FB-BAL for microbiological diagnosis we sample 6 lobes (including lingula) as this is known to increase the rate of culture positive procedures in children with cystic fibrosis. We investigated if this is also the case in children with PBB.MethodsWe undertook a retrospective case note review of 50 children investigated for suspected PBB between May 2011 and November 2013.ResultsThe median (IQR) age at bronchoscopy was 2.9 (1.7–4.4) years and the median (IQR) duration of cough was 11 (8.0–14) months. Positive cultures were obtained from 41/50 (82%) and 16 (39%) of these patients isolated ≥2 organisms. The commonest organisms isolated were Haemophilus influenzae (25 patients), Moraxella catarrhalis (14 patients), Staphylococcus aureus (11 patients) and Streptococcus pneumoniae (8 patients). If only one lobe had been sampled (as per the European Respiratory Society guidance) 17 different organisms would have been missed in 15 patients, 8 of whom would have had no organism cultured at all. The FB-BAL culture results led to an antibiotic other than co-amoxiclav being prescribed in 17/41 (41%) patients.ConclusionsBacterial distribution in the lungs of children with PBB is heterogeneous and organisms may therefore be missed if only one lobe is sampled at FB-BAL. Positive FB-BAL results are useful in children with PBB and can influence treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bacterial Distribution in the Lungs of Children with Protracted Bacterial Bronchitis

et al. 2014

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“…Non-bronchoscopic bronchoalveolar lavage (BAL) samples were collected from ventilated infants by one of the investigators (MGS) or a experienced respiratory physiotherapist, in accordance with the European Respiratory Society 2000 guidelines and our earlier studies [10], [13]. A weight adjusted volume of 0.9% saline (1 ml/kg) was instilled twice and then for a minimal dwell time to minimise any urea dialysis effect [14], [15].…”

Section: Methodsmentioning

confidence: 99%

Severe Respiratory Syncytial Virus Bronchiolitis in Infants Is Associated with Reduced Airway Interferon Gamma and Substance P

et al. 2007

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BackgroundSevere human respiratory syncytial virus (hRSV) bronchiolitis in previously well infants may be due to differences in the innate immune response to hRSV infection. Aim: to determine if factors mediating proposed mechanisms for severe bronchiolitis differ with severity of disease.Methodology/Principle Findings197 infants admitted to hospital with hRSV bronchiolitis were recruited and grouped according to no oxygen requirement (n = 27), oxygen dependence (n = 114) or mechanical ventilation (n = 56). We collected clinical data, nasopharyngeal aspirate (NPA) and if ventilated bronchoalveolar lavage (BAL). Interferon-gamma (IFN-γ), substance P (SP), interleukin 9 (IL-9), urea and hRSV load, were measured in cell free supernatant from NPA and BAL. Multivariate analysis compared independent effects of clinical, virological and immunological variables upon disease severity. IFN-γ and SP concentrations were lower in NPA from infants who required oxygen or mechanical ventilation. Viral load and IL-9 concentrations were high but did not vary with severity of disease. Independent predictors of severe disease (in diminishing size of effect) were low weight on admission, low gestation at birth, low NPA IFN-γ and NPA SP. Nasal airway sampling appears to be a useful surrogate for distal airway sampling since concentrations of IFN-γ, SP, IL-9 and viral load in NPA correlate with the same in BAL.ConclusionsOur data support two proposed mechanisms for severe hRSV disease; reduced local IFN-γ response and SP mediated inflammation. We found large amounts of hRSV and IL-9 in airways secretions from the upper and lower respiratory tract but could not associate these with disease severity.

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“…FFB was done according to criteria standardized by the European Respiratory Society [21]. BAL was done by wedging the bronchoscope into the selected bronchus and 1-ml/kg aliquots of sterile saline were instilled three times.…”

Section: Methodsmentioning

confidence: 99%

BALF Nitrite as an Indicator of Inflammation in Children with Cystic Fibrosis

Çetin

Göçmen²,

Ki̇per³

et al. 2004

Respiration

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Background: A unique substance reflecting the degree of inflammation localized to the lower respiratory tract in patients with cystic fibrosis (CF) has been the concern of several investigators and nitric oxide has gained interest for this purpose in the last decades. Objectives: The aim of this study was to evaluate the cytokine and nitrite levels by showing the relationship between them in serum and bronchoalveolar lavage fluid (BALF) of patients with CF and patients in which flexible fiberoptic bronchoscopy (FFB) was applied because of indications other than infection. Methods: 20 children with CF with mean age 8.2 years and 10 children as control group with mean age 4.2 years were included in the study. Cultures for aerobes, anaerobes, fungi and mycobacteria, cell differentials, cytokine and nitrite measurements were made from BALF specimens. White blood cell (WBC) count, erythrocyte sedimentation rate (ESR), quantitative C-reactive protein (QCRP), cytokine and nitrite levels were measured from serum samples. Results: BALF neutrophil, TNF-α, IL-8 and nitrite levels were significantly higher in patients with CF than control patients. There was no correlation between serum and BALF cytokine and nitrite levels. However, there was a significantly positive correlation between BALF IL-8 and nitrite levels in patients with CF (r = 0.5) and also in control patients (r = 0.6). Conclusions: The results suggest that BALF nitrite levels reflect the degree of inflammation localized to lower respiratory tract and may be a useful indicator of airway inflammation for patients with CF.

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Bronchoalveolar lavage in children. ERS Task Force on bronchoalveolar lavage in children. European Respiratory Society

Cited by 352 publications

References 75 publications

Bacterial Distribution in the Lungs of Children with Protracted Bacterial Bronchitis

Bacterial Distribution in the Lungs of Children with Protracted Bacterial Bronchitis

Severe Respiratory Syncytial Virus Bronchiolitis in Infants Is Associated with Reduced Airway Interferon Gamma and Substance P

BALF Nitrite as an Indicator of Inflammation in Children with Cystic Fibrosis

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