Bronchoalveolar Lavage Technique Research Articles

A Bibliometric Analysis of the Role and Research Trending of Bronchoalveolar Lavage in the Diagnosis and Treatment of Ventilator-Associated Pneumonia.

Ventilator-associated pneumonia (VAP) is one of the most common complications in intensive care units (ICUs) and negatively affects patient outcomes. Despite its widespread use as a diagnostic and therapeutic measure, the application and effectiveness of bronchoalveolar lavage (BAL) in the management of VAP require further exploration. This study aimed to evaluate the research dynamics, major trends, and scientific networks of BAL in the diagnosis and treatment of VAP using bibliometric analysis. Literature from the Web of Science database on BAL for the diagnosis and treatment of VAP from 1990 to 2024 was screened and analyzed. Keyword co-occurrence, trend analysis, and citation burst analyses were conducted using CiteSpace to identify research hotspots, core authors, institutions, and countries, as well as the evolution of research domains. The bibliometric analysis included 968 publications. Trend analysis indicated growing interest in BAL techniques, particularly in the categories of RESPIRATORY SYSTEM (burst score: 27.82) and MEDICINE, RESEARCH, and EXPERIMENTAL (burst score: 7.41). The co-citation analysis highlighted influential authors in the field, such as Torres(burst score: 9.35), Croce (burst score: 5.86), and Meduri(burst score: 5.71). Keyword analysis results revealed core clusters in the treatment of VAP with BAL, including "nonbronchoscopic lavage" (silhouette value: 0.703), "ICU-acquired infection" (silhouette value: 0.7), and "ventilator-associated tracheobronchitis" (silhouette value: 0.637). Additionally, geographic analysis showed that North America and Europe dominated the research in this field. Recently, research trends regarding protected specimen brushes and quantitative culture techniques have emerged. This study found broad applications of BAL in VAP management, especially in improving diagnostic accuracy and treatment outcomes. Optimized strategies such as improvement of lavage techniques and multidisciplinary collaboration may emerge as potential research hotspots in the future.

Utility of bronchoalveolar lavage for COVID-19: a perspective from the Dragon consortium.

Diagnosing COVID-19 and treating its complications remains a challenge. This review reflects the perspective of some of the Dragon (IMI 2-call 21, #101005122) research consortium collaborators on the utility of bronchoalveolar lavage (BAL) in COVID-19. BAL has been proposed as a potentially useful diagnostic tool to increase COVID-19 diagnosis sensitivity. In both critically ill and non-critically ill COVID-19 patients, BAL has a relevant role in detecting other infections or supporting alternative diagnoses and can change management decisions in up to two-thirds of patients. BAL is used to guide steroid and immunosuppressive treatment and to narrow or discontinue antibiotic treatment, reducing the use of unnecessary broad antibiotics. Moreover, cellular analysis and novel multi-omics techniques on BAL are of critical importance for understanding the microenvironment and interaction between epithelial cells and immunity, revealing novel potential prognostic and therapeutic targets. The BAL technique has been described as safe for both patients and healthcare workers in more than a thousand procedures reported to date in the literature. Based on these preliminary studies, we recognize that BAL is a feasible procedure in COVID-19 known or suspected cases, useful to properly guide patient management, and has great potential for research.

Differential cell analysis in ovine bronchoalveolar lavage fluid: Effect of different sampling methods and seasons.

Bronchoalveolar lavage (BAL) is a method for collecting the cellular and fluid components of the airway surface in the lungs. The assessment of differential cell profiles is potentially valuable in the diagnosis of pulmonary diseases, but there is no information about the normal BAL profiles in the Gezel breed. This study aimed to characterize the normal cryptologic findings of BAL with Gezel sheep. Twenty healthy sheep (15 females: 5 males, bodyweight: 55-65 kg) were sedated with xylazine (0.02-0.04 mg/kg IV). Two methods; the transtracheal bronchoalveolar lavage technique and the bronchoscopic bronchoalveolar lavage using a scope were evaluated. Sampling was performed in the summer and winter seasons. Normal value (Mean ± SEM) for total cell, macrophage, lymphocyte, neutrophil, epithelial, and bronchial cells in BAL sampled in summer were (343.75 ± 30.23), ) 24.50 ± 2.62), (2.81 ± 0.51), (1.43 ± 0.88), and (3.12 ± 0.32), respectively. The normal values for the total cell, macrophage, lymphocyte, neutrophil, epithelial, and bronchial cells in BAL sampled in winter were (355.55 ± 37.67), (59.11 ± 4.30), (21.33 ± 3.10), (3.88 ± 1.07), (8.88 ± 3.78), and (6.33 ± 1.44), respectively. No significant change in the percentage of neutrophils was detected between seasons, although the percentages of bronchial and epithelial cells in winter were significantly high (p < 0.05). Except for the mentioned cases, neither the total cell number nor the percentage differential cell populations of BAL changed significantly (p < 0.05) in different sampling methods and seasons. Normal BAL profiles in the Gezel breed were determined and could be used in result interpretations. Also, both sampling methods can be used without significantly affecting the results.

CONSISTENCY BETWEEN BRONCHOALVEOLAR LAVAGE AND ENDOTRACHEAL ASPIRATE IN THE DIAGNOSIS OF VENTILATOR-ASSOCIATED PNEUMONIA

Background &#x0D; Ventilator-associated pneumonia (VAP) is a common nosocomial lung infection. Quick and accurate identification of the causative pathogen is crucial to improve prognosis. To date, the literature is controversial regarding whether endotracheal aspirate (ETA) can be used as an alternative to bronchoalveolar lavage (BAL) in VAP diagnosis.&#x0D; Objectives &#x0D; To evaluate the consistency between the results of BAL and ETA in the diagnosis of early- and late VAP and to determine the microbial profiles of the involved microorganisms and their antimicrobial susceptibility. &#x0D; Patients and Methods&#x0D; This is a single-centre prospective study that included 50 VAP-suspected patients conducted at Shar Hospital, Sulaimani, Iraq, from July 2021 to February 2022. The patients were categorised into early VAP and late VAP. For each patient, both ETA and BAL techniques were used to obtain samples for microbiological analysis and antimicrobial susceptibility testing.&#x0D; Results&#x0D; Ten (20%) patients developed early VAP, and 40 (80%) developed late VAP. The culture results of samples obtained by BAL showed microbial growth in 45 (90%) of the cases. Meanwhile, ETA resulted in microbial growth in 40 (80%) patients. In 45 (90%) of the samples, both techniques yielded the same results regarding microbial growth in the cultures. Among the 45 samples with the same growth results, 35 (70%) showed the same type of microbes, and 5 (10%) showed no microbial growth, indicating substantial agreement. In both BAL and ETA, Pseudomonas aeruginosa, Staphylococcus aureus, and Acinetobacter baumannii were the most frequently isolated pathogens. Both early- and late-VAP were associated with a high frequency of multidrug-resistant microorganisms, 6 (75%) and 25 (56.8%), respectively. However, extensively drug-resistant/pan-drug-resistant isolates were much more common in late-VAP patients (12, 27.3%). &#x0D; Conclusion&#x0D; ETA can be a reliable, non-invasive alternative to BAL in VAP diagnosis associated with rapid and relatively accurate results.

Monitoring practices of chronic lung allograft dysfunction in pediatric lung transplantation.

Chronic lung allograft dysfunction (CLAD) continues to negatively impact the survival of pediatric lung transplant (LTx) recipients. Current consensus guidelines are adult-focused. We sought to examine CLAD detection and monitoring practices at pediatric LTx programs. We conducted a survey among the International Pediatric Lung Transplant Collaborative. Questions consisted of practitioner's experience, LTx program demographics, and querying tests used for CLAD surveillance and detection. Investigations queried included: chest x-ray (CXR), chest computed tomography (CT), lung magnetic resonance imaging (MRI), ventilation/perfusion scanning, conventional pulmonary function testing (PFT), multiple breath washout (MBW), infant/preschool PFT, bronchoalveolar lavage, transbronchial biopsies (TBBx), or other tissue sampling techniques. Preferences for certain modalities over others were questioned based on a five-point Likert scale. Twenty-four of 25 programs responded. Chest CT and CXR are used generally for both CLAD surveillance and detection. No programs use lung MRI clinically, it may have some utility in the future. While all centers use conventional PFT, MBW, and infant/preschool PFT are used in one-fifth and one-third of centers, respectively. While the majority of programs use TBBx, only 41.7% would obtain a diagnosis based on tissue histopathology over noninvasive techniques if CLAD is suspected. Utilization of biomarkers is still limited. Our results indicate continued use of conventional PFT along with chest CT and less so CXR for CLAD detection and monitoring in the large majority of centers. Infant/preschool PFTand novel methods such as MBW are used in a few centers only. Respondents agreed there is a timely need for pediatric consensus guidelines on CLAD detection and monitoring.

Utilization of Gelatin to Assess Lung Anatomy: A Novel Tool for Post‐Graduate Medical Education

We present a simple, inexpensive, and novel technique to assess lung anatomy in cadavers: introduction of a fluid mixture, via bronchoalveolar lavage, that will gelatinize within the lung and define the distribution of instilled fluid. The gelatinous fluid is infused with surgical ink and, thus, appears bright blue in gross anatomical inspection. Furthermore, the gelatin is radiopaque and can easily be identified in chest radiographs and computed tomography scans. Also, the gelatin does not interfere with histological staining. The fluid can be instilled via bronchoalveolar lavage techniques; thus, it can be used in medical education to confirm lavage target sites. Accordingly, the method has educational value for pulmonary / critical care and radiology residents.

Challenging the “Culture” of the Tracheal Aspirate

The tracheal aspirate (TA) culture is commonly ordered in the NICU, but it has low sensitivity and specificity, limited by contamination. Interpretation of a TA culture out of context can lead to antibiotic overuse, which should be avoided. Clinicians should practice caution in the diagnosis of congenital pneumonia and use newer, published approaches to the diagnosis of ventilator-associated pneumonia in neonates. A subset of neonatal patients with risk factors of maternal fever or chorioamnionitis requiring intubation may benefit from TA culture performed within 12 hours after birth, to help identify an organism when blood culture may be negative, and tailor antimicrobial therapies. The more invasive, but more sensitive, technique of nonbronchoscopic bronchoalveolar lavage should be considered in older infants when bacterial isolation from the lower respiratory tract is necessary, because TA culture cannot distinguish between colonization and infection in that population.

Diagnostic Yield of Fibre-Optic Bronchoscopy in Clinically and Radiologically Suspected Cases of Bronchial Carcinoma

Background: Bronchial carcinoma is one of the most common neoplastic disorders in which the majority of patients present at advanced stages. Fibre- optic bronchoscopy is an established investigational procedure in bronchial carcinoma, and is of paramount importance in tumor staging and hispathological typing. But there are a few studies regarding the diagnostic yield of fibre-optic bronchoscopy in our country.Methods: This was a cross-sectional study done in the respiratory medicine ward of National Institute of Diseases of the Chest and Hospital (NIDCH), Mohakhali, Dhaka from September 2011 to February 2012. All consecutive patients who were suspected clinically and radiologically as a case of bronchial carcinoma and attending in NIDCH were included in this study. There were inclusion and exclusion criteria for selecting the patients. A standard proforma and questionnaire were designed and filled up for each patient. Data was analyzed in computer using software (SPSS) and mean ± SD was applied.Results: Among the total 68 cases 56 patients (82.35%) revealed bronchial carcinoma by fibre-optic bronchoscopy (FOB). Among the 50(73.63%) patients having central lung lesion, 42(84%) patients revealed bronchial carcinoma by bronchial biopsy. Bronchial brushing was taken from 30 patients having central lung lesion and it revealed bronchial carcinoma in 18 patients( 60%). Peripheral lung lesions was found in 18 cases. Bronchial biopsy and bronchial brushing were taken in 6 cases but revealed nonspecific result. Bronchoalveolar lavage was taken in all 68 cases and revealed bronchial carcinoma in 46(67.65%) cases. Bronchial biopsy, bronchial brushing and bronchoalveolar lavage were performed on 56, 30 and 68 cases which yielded bronchial carcinoma in 42 (75%), 18 (60%) and 46 (67.65%) cases respectively. Stepwise performance of bronchial biopsy, bronchial brushing and bronchoalveolar lavage provided a diagnostic yield of 82.35% of cases who had subsequently proven bronchial carcinoma. Combined biopsy, brushing and bronchoalveolar lavage technique is more effective than single technique (P=&lt;O.O01), which is highly significant, gives the diagnostic yield of 82.35%. Out of 50 patients having central lesion in chest X-ray the fibre-optic bronchoscopy yielded bronchial carcinoma in 45 patients (90%). But out of 18 patients having peripheral lesion in chest X-ray the fibre-optic bronchoscopy revealed bronchial carcinoma in 11 patients (61.11%). So fibre-optic bronchoscopy is more effective in the diagnosis of central mitotic lesion than peripheral mitotic lesion. The effectiveness of the combined technique (bronchial biopsy, bronchial brushing and bronchoalveolar lavage all together) is increased to 82.35%. The effectiveness is significantly lower when applied a single technique.Conclusion: By Combined bronchial biopsy, brushing and bronchoalveolar lavage 82.35% cases were diagnosed as bronchial carcinoma which is significantly higher than a single technique. Bronchoalveolar lavage may be an important diagnostic procedure in the peripheral lung lesions.TAJ 2014; 27(2): 50-57

Diagnosis of bovine dictyocaulosis by bronchoalveolar lavage technique: A comparative study using a Bayesian approach

Bovine dictyocaulosis is a pulmonary parasitic disease present in temperate countries, with potential important clinical and economic impacts. The Baermann technique is routinely used despite its low sensitivity in adult cows. Recently developed serological tests seem to offer better sensitivity, but validations of these tests in field conditions are few. We aimed to study two non-previously evaluated diagnosis methods of dictyocaulosis based on bronchoalveolar lavage sampling (BAL), which allows finding lungworm stages in the lungs as well as determination of eosinophilia. We compared them to the Baermann technique and serological tests. As no gold standard was available, we performed a Bayesian analysis by the simultaneous use of latent class and mixture models. The study was carried out during the 2015 pasture season on 60 adult cows originating from 11 herds with clinical signs of dictyocaulosis, and 10 apparently healthy cows originating from the teaching herd of VetAgro Sup, in France. Prevalence of infection was highly variable among herds with clinical signs (10–90%). Despite a maximal specificity (100%), the sensitivity of parasitological methods was low (7.4% for the Baermann sedimentation and 24.7% for the examination of BAL fluids). Better results were observed with serology (Se = 74.9%, Sp = 85.5%) with an optimal cut-off value estimated at 0.397 for the optical density ratio. Even better results were obtained with the count of eosinophil in BAL (Se = 89.4%, Sp = 85.2%) with an optimal cut-off value estimated at 4.77% for the eosinophil proportion. The BAL is a relevant diagnostic method of dictyocaulosis for practitioners due to the opportunity to perform two analyses (direct parasitic research and the eosinophil count) and to its good sensitivity and specificity.

Exhalation Air Fungal Culture of Mechanically Ventilated Aspergillosis Suspected Patients in Concordance with Other Conventional Diagnostic Techniques

Aspergillosis remains one of the most challenging areas of illness. It has recently emerged as a world-wide health care problem, owing to extensive use of broad spectrum antibiotics, immunosuppressive agents and increasing population of terminally ill and debilitated patients. The ultimate aim of this investigation is to minimize morbidity and mortality of mechanically ventilated aspergillosis suspected patients, who have been notoriously difficult to be diagnosed and treated, by developing an accurate and easy diagnostic tool comparable to other conventional methods. Two hundred twenty seven suspected aspergillosis patients were screened for fungal infection using different conventional tools to evaluate different respiratory specimens sputum, bronchoalveolar lavage, plural fluid, blood, biopsy and ELISA technique for galactomannan and (1-3)-β-D-glucan antigens in serum and bronchoalveolar lavage. Four Aspergillus species (A. niger, A. fumigatus, A. flavus and A. terreus) were isolated and identified morphologically and genetically using the conventional diagnostic tools from suspected patients in all positive cultures. The results of the exhalation air of twenty three mechanically ventilated aspergillosis suspected patients came in accordance with those of the conventional methods used. Thus, exhalation air culture is an easily performed bedside tool for diagnosis of aspergillosis in ventilated patients.

A Prospective Randomized Study Comparing Manual and Wall Suction in the Performance of Bronchoalveolar Lavage

Background: Bronchoalveolar lavage (BAL) may be performed using a hand-held syringe or wall suction. Objectives: The aim was to study BAL volume and diagnostic yields based on BAL technique. Methods: A total of 220 consecutive patients undergoing BAL at our center were included. Manual aspiration was performed in 115 patients (group 1), and wall suction (<50 mm Hg of negative pressure) was used in 105 patients (group 2). All bronchoscopies were performed under conscious sedation applying topical anesthesia with lidocaine. Three 50-ml sterile saline aliquots were instilled in all patients. Results: The mean total amount of fluid recovered was 67 ± 20 ml in group 1 and 55 ± 22 ml in group 2 (p < 0.001). More patients in the manual aspiration group met American Thoracic Society criteria (recovery of ≥30% of instilled fluid) for an optimal BAL (81 vs. 59%; p < 0.001). The quantity of recovered fluid was also related to BAL location (p < 0.001) and radiologic findings (p = 0.002). Forty-eight (22%) BALs were diagnostic (23 in group 1 and 25 in group 2), including 37 positive bacterial cultures, 6 positive stains for Pneumocystis, and 5 cases of malignancy. No statistically significant difference in diagnostic yield was observed between the two groups. A BAL diagnosis was more likely in patients with certain radiologic (p = 0.033) and endoscopic findings (p = 0.001). When taking into account all bronchoscopic techniques performed during the procedure (e.g. biopsies, brushing, etc.), bronchoscopy was diagnostic in 37% of patients. Conclusions: Manual aspiration is superior to wall suction during BAL yielding a larger quantity of aspirate. Diagnostic yields are similar for both techniques.

Comparison of diagnostic performances among bronchoscopic sampling techniques in the diagnosis of peripheral pulmonary lesions.

There are many sampling techniques dedicated to radial endobronchial ultrasound (R-EBUS) guided flexible bronchoscopy (FB). However, data regarding the diagnostic performances among bronchoscopic sampling techniques is limited. This study was conducted to compare the diagnostic yields among bronchoscopic sampling techniques in the diagnosis of peripheral pulmonary lesions (PPLs). A prospective study was conducted on 112 patients who were diagnosed with PPLs and underwent R-EBUS-guided FB between Oct 2012 and Sep 2014. Sampling techniques-including transbronchial biopsy (TBB), brushing cell block, brushing smear, rinsed fluid of brushing, and bronchoalveolar lavage (BAL)-were evaluated for the diagnosis. The mean diameter of the PPLs was 23.5±9.5 mm. The final diagnoses included 76 malignancies and 36 benign lesions. The overall diagnostic yield of R-EBUS-guided bronchoscopy was 80.4%; TBB gave the highest yield among the 112 specimens: 70.5%, 34.8%, 62.5%, 50.0% and 42.0% for TBB, brushing cell block, brushing smear, rinsed brushing fluid, and BAL fluid (BALF), respectively (P<0.001). TBB provided high diagnostic yield irrespective of the size and etiology of the PPLs. The combination of TBB and brushing smear achieved the maximum diagnostic yield. Of 31 infectious PPLs, BALF culture gave additional microbiological information in 20 cases. TBB provided the highest diagnostic yield; however, to achieve the highest diagnostic performance, TBB, brushing smear and BAL techniques should be performed together.

Bronchoalveolar lavage is an ideal tool in evaluation of local immune response of pigs vaccinated with Pasteurella multocida bacterin vaccine.

Aim:The aim was to study the bronchoalveolar lavage (BAL) technique in evaluating the local immune response of pig immunized with Pasteurella multocida bacterin vaccine.Materials and Methods:Weaned piglets were immunized with formalin-inactivated P52 strain of P. multocida bacterin and evaluated for pulmonary immune response in BAL fluid. BAL was performed before vaccination and at different post vaccination days. The BAL fluid was assayed using enzyme-linked immunosorbent assay to study the development of P. multocida specific antibody isotypes and also evaluated for different cell populations using standard protocol.Results:The average recovery percentage of BAL fluid varies from 58.33 to 61.33 in vaccinated and control group of piglets. The BAL fluid of vaccinated pigs showed increase in antibody titer up to 60th days post vaccination (8.98±0.33), IgG being the predominant isotype reached maximum titer of 6.12±0.20 on 45th days post vaccination, followed by IgM and a meager concentration of IgA could be detected. An increased concentration of the lymphocyte population and induction of plasma cells was detected in the BAL fluid of vaccinated pigs.Conclusion:Though intranasal vaccination with P. multocida plain bacterin vaccine could not provoke a strong immune response, but is promising as lymphocyte population was increased and plasma cells were detected. BAL can be performed repeatedly up to 3/4 months of age in pigs to study pulmonary immune response without affecting their health.

Description of an Automated Method for Urea Nitrogen Determination in Bronchoalveolar Lavage Fluid (BALF) of Neonates and Infants

Bronchoalveolar lavage (BAL) partially recovers both the instilled saline and the alveolar fluid, so-called epithelial lining fluid (ELF), but a correction for the dilution due to the BAL technique itself is needed to know the amount of recovered ELF. In this regard, urea nitrogen may be useful and has been proposed to calculate ELF. The aim of the present study was to develop and validate a new method to measure urea nitrogen in BAL fluid (BALF). We used 19 BALF samples obtained from neonates and infants with different respiratory conditions. The urea nitrogen assay was carried out on Cobas c311 analyzer (Roche Diagnostics). A validation study shows that the method is perfectly linear (R(2) = 0.999), sensitive (limit of detection = 0.055 mg/dL; limit of quantification = 0.16 mg/dL), repeatable (low = 0.15 ± 0.02, 13.3%; high = 1.80 ± 0.02, 1.1%), reproducible (low = 0.14 ± 0.02, 14.2 %; high = 1.76 ± 0.04, 2.2 %) with accuracy ranging between 93-96%. Our results support the robustness of validated procedure since the described method appears simple, precise, rapid, and suitable for routine analysis. Thus, it may be used to correct concentration of various noncellular BAL components and calculate their ELF amounts in neonates and infants.

Bronchoalveolar lavage (BAL) in tapirs (Tapirus terrestris) with Mycobacterium tuberculosis

This paper describes the in vivo Bronchoalveolar lavage (BAL) technique by endoscopy in tapirs (Tapirus terrestris) with clinical signs of tuberculosis. The technique was performed in two tapirs, male and female, from Curitiba Zoo, Paraná, Brazil. A flexible endoscope and a polyethylene catheter were used after the chemical restraint of the animals. For BAL technique, 60mL of saline 0.9% were infused with a polyethylene catheter, introduced by the endoscope's working channel, and 15mL of BAL were recovered, analyzed and submitted to cytocentrifugation. Slides were stained by Papanicolaou, periodic acid-Schiff (PAS) and Ziehl-Neelsen methods contained high quantity of inflammatory cells on light microscopy (macrophages 27.5%, lymphocytes 0.5%, neutrophis 67% and eosinophis 5%). BAL samples were submitted to culture, bacilloscopy and PCR and were negative for both animals. Based on this study, it was concluded that the bronchoalveolar lavage technique in tapirs is feasible, simple, noninvasive, practical and fast, providing an important clinical information in vivo regarding the functional status of the lower respiratory tract.

A national survey of the diagnosis and management of suspected ventilator-associated pneumonia

BackgroundVentilator-associated pneumonia (VAP) affects up to 20% of patients admitted to intensive care units (ICU). It is associated with increased morbidity, mortality and healthcare costs. Despite published guidelines, variability in...

Effect of bronchoalveolar lavage on the heart rhythm and conduction of the children with severe pneumonia

To observe the effect of bronchoalveolar lavage on the heart rhythm and conduction of children with severe pneumonia through monitoring the electrocardiogram change of different step of the bronchoalveolar lavage, for proving the safety of the operation of bronchoalveolar lavage from the perspective of cardiac electrophysiology. From July 2011 to March 2012, 30 patients who were hospitalized in pneumology department of Dalian Children's Hospital and met the inclusion criteria and therapeutic indications of bronchoalveolar lavage were chosen. They were 3 to 12 years old, the average age was 5.3 years, including 17 boys and 13 girls, the ratio of boys and girls is 1.3: 1. Continuous sampling the electrocardiogram before and during the process including anesthesia, entering into glottis, lavage, aspiration, and revive, and recording the heart rate, rhythm amplitude and width of P wave, the PR interval, the form and width of QRS complex were also measured. The recorded data were analyzed and statistical analysis to reflect the change of the cardiac electrophysiology. The incidence of heart rate increase was 100.0%, 26 (86.7%) patients began to emerge after anesthesia, the rest of the patients also developed heart rate increase after the start of bronchoscopic operation. All patients had sinus tachycardia, and were most obvious in the progress of lavage and revive. In the process of entering into glottis, lavage, aspiration, 13 (43.3%) patients had arrhythmia episodes. Types of arrhythmia included sinus bradycardia, atrioventricular block and premature beat. Incidences of intraoperative arrhythmia compared with the pre- and post-operation were all statistically significantly different (P = 0.00). The most common arrhythmia were premature beat, in 17 of the 30 cases there were premature beat including 9 cases with atrial premature beats and 8 cases ventricular premature contraction. Two patients had III° atrioventricular block accompanied by serious sinus bradycardia. All kinds of arrhythmias except sinus tachycardia disappeared after the operation was ended. Five patients (16.7%) had PR interval prolongation. Five patients (16.7%) had incomplete right bundle branch block (IRBBB) . Incidences of IRBBB compared with the pre-operation and post-operation were all not significantly different [13.3% (n = 4) vs. 0(n = 0) and 3.3% (n = 1), all P > 0.05]. Different operating progress made no significant difference in the measurement value of electrocardiogram[13.3% (n = 4) vs. 0(n = 0) and 3.3% (n = 1), all P > 0.05], but showed the most notable effect on heart rate. Bronchoalveolar lavage can influence the heart rhythm and conduction, but most of the influence with pathological significance are transient. Cardiac electrophysiological changes were the most obvious in endotracheal operation with the risk of malignant arrhythmia but the risk is low, the bronchoalveolar lavage technique is safe. The contingency plans for dealing with all kinds of adverse reactions must be ready before the operations of bronchoalveolar lavage. During the procedure, the patient's ECG changes should be closely monitored to reduce the incidence of adverse reactions.

Quantitative measurement of influenza virus replication using consecutive bronchoalveolar lavage in the lower respiratory tract of a ferret model

The ferret is an established animal model of influenza virus infection. Although viral replication in the upper respiratory tract is usually measured with consecutively collected nasal washes, daily evaluation of viral replication in the lung is limited because a large numbers of ferrets need to be sacrificed at consecutive time points. To overcome this limitation, we performed a virus quantification assay using bronchoalveolar lavage (BAL) fluid. This non-invasive BAL technique allows consecutive quantification of virus replication in the lungs of living ferrets. Our method can be used for the longitudinal evaluation of virus tropism in the lower respiratory tract.

Change in agglomeration status and toxicokinetic fate of various nanoparticles in vivo following lung exposure in rats

The deposition characteristics in lungs following inhalation, the potential toxic effects induced and the toxicokinetic fate including a possible translocation to other sites of the body are predominantly determined by the agglomeration status of nanoscaled primary particles. Systemic particle effects, i.e. effects on remote organs besides the respiratory tract are considered to be of relevant impact only for de-agglomerated particles with a nanoscaled aspect. Rats were exposed to various types of nanoscaled particles, i.e. titanium dioxide, carbon black and constantan. These were dispersed in physiologically compatible media, e.g. phosphate buffer, sometimes including auxiliaries. Rats were treated with aqueous nanoparticle dispersions by intratracheal instillation or were exposed to well-characterized nanoparticle aerosols. Subsequently, alterations in the particle size distribution were studied using transmission electron microscopy (TEM) as well as the bronchoalveolar lavage (BAL) technique. Based on the results in various approaches, a tendency of nanoscaled particles to form larger size agglomerates following deposition and interaction with cells or the respiratory tract is predominant. The contrary trend, i.e. the increase of particle number due to a disintegration of agglomerates seems not to be of high relevance.

In this issue – July 2012

In this issue – <scp>J</scp>uly 2012