The significance of bronchoalveolar or bronchial lavage in ARDS: Validation in 180 patients

Background: Sepsis, pneumonia, aspiration are major causes of ARDS, but other various diseases may cause ARDS. Objective: To evaluate significance of bronchoalveolar lavage (BAL) or bronchial lavage (BL) in ARDS. Methods: 180 patients met the Berlin definition in our institution from Oct. 2004 to Dec. 2014. When we could not identify the cause of ARDS by clinical history, physical findings, blood tests, culture tests, we performed BAL or BL under mechanical ventilation. We analyzed their results of examinations, final diagnoses and outcomes. Results: BAL(n=22) or BL (n=5) was performed in 27 of 180(15%) cases. In 19 of 27(70%) cases, we obtained diagnostic information about causes of ARDS by BAL or BL Thirteen (48%) cases were due to infection, 6(22%) were suspected to drug-associated. In patients whose BALF represented neutrophilic cellular pattern, 28-day and 60-day survival rates were significantly lower (P < 0.05) and ventilator free days was shorter than in patients whose BALF represented lymphocytic or eosinophilic cellular pattern (P=0.005). Although 28-day and, 60-day survival rates tended to be higher in patients whose causes of ARDS were identified than those in patients whose causes not identified, there were no statistically significant differences. Conclusion: Bronchoscopic evaluation in ARDS may be beneficial to identify the cause and to predict prognosis.