Abstract
The study assesses the correlation between lipid-laden macrophage index in tracheal secretions (tLLMI) acquired at the time of direct laryngobronchoscopy (DLB) with the bronchoalveolar LLMI (aLLMI) collected via flexible bronchoscopy. Assessment of lipid-laden macrophages within bronchoalveolar lavage fluid has been proposed to be diagnostically helpful in evaluation of tracheobronchial inflammation. However, measurement requires flexible bronchoscopy with bronchoalveolar lavage, which can be associated with oxygen desaturation and post-operative fever. Quantification of lipid-laden macrophages in tracheal material has not been explored. The study demonstrates that the LLMI in tracheal aspirates collected at the time of DLB correlates with that of aspirates measured directly from the lower airways.
Highlights
Chronic pulmonary aspiration, a condition in which there is intermittent or persistent entry of alimentary contents into the airway, can be responsible for significant pulmonary comorbidity including recurrent aspiration pneumonia, exacerbation of asthma, chronic bronchitis, bronchiectasis, stridor and apnea [1,2,3]
Because lipids present in aspirated gastric contents are phagocytosed by macrophages it has been postulated that analysis of lipid content in macrophages could be a useful indicator of pulmonary aspiration of gastric contents
The primary outcome measure was comparison of the reference test of lipid-laden macrophage index (LLMI) in bronchoalveolar lavage (BAL) compared to the index test we proposed by way of tracheal aspirates
Summary
A condition in which there is intermittent or persistent entry of alimentary contents into the airway, can be responsible for significant pulmonary comorbidity including recurrent aspiration pneumonia, exacerbation of asthma, chronic bronchitis, bronchiectasis, stridor and apnea [1,2,3]. This condition occurs when there is a failure of the normal airway protective mechanisms. Histopathologic and radiological evidence of lung injury and clinicians use multiple modalities to evaluate aspiration including chest x-rays, computed tomography and diagnostic procedures including speech and swallow studies.
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