During BAL, coughing, which may also increase the risk for bronchial contamination, can be prevented in part by instilling saline solution warmed to body temperature. flovent inhaler
Recently, three methodologies have been introduced to avoid or minimize bronchoscopic contamination of the BAL fluid: nonbronchoscopic BAL, nonbronchoscopic protected BAL, and bronchoscopic protected BAL.
Gaussorgues et al have reported on a technique to perform blind nonbronchoscopic BAL (NB-BAL) in intubated patients using a cuffed 7 Fr right heart catheter. In 13 patients, NB-BAL and open-lung biopsy of the same lobe were performed immediately after death while mechanical ventilation was continued. Among the ten positive BAL cultures (nonquan-titative), lung biopsy specimen showed histologic pneumonia in 9 patients and NB-BAL correctly identified 13 of the 14 organisms isolated in lung cultures.
Rouby et al have described a technique to perform nonbronchoscopic protected BAL in intubated patients using a double-catheter system. A large catheter (1.7 mm internal diameter [ID]) has a distal polyethylene glycol plug and is blindly advanced into the distal airways. Once wedged in a peripheral bronchus, the plug is expelled with 10 ml of air and a second catheter (0.8 mm ID) is passed through the first one and advanced as far as possible, at least 3 cm beyond the distal tip of the first catheter.
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