A simple method of reducing complications of pediatric nonbronchoscopic bronchoalveolar lavage

Our objective was to determine whether a simple method of maintaining positive pressure ventilation during nonbronchoscopic bronchoalveolar lavage (NB‐BAL) would successfully reduce the incidence and/or severity of desaturation events. Our design was a clinical trial with historical controls. Seventy ventilated pediatric patients undergoing diagnostic NB‐BAL participated. Two NB‐BAL techniques were compared: 1) the “unsealed” method, where the suction catheter was passed through an open system, maintaining oxygenation but not airway pressure; and 2) the “sealed” technique, which was identical except that the catheter was passed through a diaphragm, maintaining positive pressure ventilation throughout. NB‐BAL was performed on 35 patients using the “unsealed” technique and 2 years later on 35 patients using the “sealed” method. Heart rate and oxyhemoglobin saturation (SaO 2 ) were recorded before, during, and after NB‐BAL. There was no difference between groups with regard to demographic data, oxygenation, or ventilatory requirements ( P  ≥ 0.1). The “sealed” group experienced a median drop in SaO 2 of 6.0% (range, −6% to 44%), and the “unsealed” group a drop of 13.0% (−2% to 61%), during NB‐BAL ( P  < 0.05). Patients with oxygenation index greater than 10 experienced the most severe desaturation events in both groups: 53.8% of patients in the “sealed” group with oxygenation index >10 desaturated to <80% vs. 91.6% in the “unsealed” group ( P  < 0.05). In conclusion, we describe a simple, inexpensive modification of the NB‐BAL technique that reduces the incidence and severity of desaturation during NB‐BAL. © 2004 Wiley‐Liss, Inc.