Preliminary results from a prospective randomized trial comparing manual vs wall suction in the performance of bronchoalveolar lavage (BAL)

Introduction: BAL may be performed using hand held siringe or wall suction. The Spanish Thoracic Society recommends manual suction following instillation of normal saline in a selected segmental bronchus. However, current clinical practice varies. We report on preliminary results from a randomized trial comparing BAL yields with both techniques. Patients & Methods: 62 consecutive patients undergoing BAL at our center were included. Manual aspiration of instilled saline was performed with 50-cc syringe applied to the bronchoscope9s suction valve, while aspiration using wall suction was performed with Results: The mean total amount of fluid recovered by manual suction was 65.4 cc (+/-18.8), whereas 45.9 cc (+/-17) were obtained by wall suction (p=0.03). Nine BALs were diagnostic (6 manual and 3 wall suction) including 4 positive bacterial cultures, 3 positive stains for Pneumocystis and 2 cases of malignancy. When taking into account all techniques during the procedure, bronchoscopy was diagnostic in 25.8%. No complications or technical failures were recorded. This is an ongoing study; results regarding diagnostic yield should be available by early 2016. Conclusions: Manual suction is superior to wall suction during BAL yielding a larger quantity of aspirate. Such findings may have implications for the diagnostic yield of this bronchoscopic technique.