This technique samples a large portion of lung parenchyma (approximately 1 million alveoli) as the alveolar surface distal to the tip of the wedged bronchoscope is estimated to be 100 times greater than that of the peripheral airways. The dilution of lung secretions in the BAL fluid is 10- to 100-fold. A colony count of 104 cfu/ml, therefore, represents 105 to IP bacteria per milliliter. Bronchoalveolar lavage, although providing a broader reflection of lung content than PSB, is subject to the same risk for contamination previously described for bronchoscopic aspirates, a factor that has limited, in part, its application in diagnosing bacterial pneumonia. buy ventolin inhalers
The diagnostic accuracy of BAL has been well established for those pneumonias caused by organisms that do not colonize the upper airway for whom contamination of the retrieved secretions does not represent a diagnostic dilemma. Bronchoalveolar lavage has replaced open-lung biopsy in diagnosing opportunistic infections in the immunosuppressed host, and its utility in detecting pathogens that cause pneumonia by the inhalation route (instead of aspiration), such as tuberculosis, Legionella, and Mycoplasma, will be discussed later.
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