M.L. SHTEINER^{1, 2}, A.V. ZHESTKOV¹, YU.I. BIKTAGIROV¹, S.A. BABANOV¹, E.A. KORYMASOV¹, E.P. KRIVOSHCHEKOV¹, A.D. PROTASOV¹, O.S. KOZLOVA¹, V.V. KULAGINA³, T.P. HURASKINA⁴, I.I. SIROTKO¹

 ¹ Samara State Medical University, Samara

² Samara City Hospital № 4, Samara

³ «REAVIZ» Medical University, Samara

⁴ Samara Hospital of the Ministry of Internal Affairs, Samara

 Contact details:

Shteiner M.L. — MD, Associate Professor of the Department of Surgery with the course of endoscopy

Address: 89 Chapaevskaya St., Samara, Russian Federation, 443099, tel.: +7 (846) 260-33-61, e-mail: [email protected]

  The authors analyzed the results of diagnostic bronchoalveolar lavage (BAL) application over a 12-year period. The results were obtained during 9252 therapeutic and diagnostic bronchoscopies (100%). In all cases the macroscopic assessment of BAL fluid was performed using the designed flow chart; acid-fast bacilli were identified. Bacterial flora and its antibiotic sensitivity were determined in 864 cases (9,34%). When disseminated processes or peripheral lesions occurred in the lungs, acid-fast bacilli and atypical cells were identified in BAL fluid; general analysis was also carried out. The macroscopic assessment of BAL fluid made a substantial contribution to the diagnostic process. Identified acid-fast bacilli and atypical cells drastically changed the treatment strategy and tactics. Identified bacterial flora adjusted the tactics in less than 6% of cases.

Key words: bronchoscopy, additional diagnostic endobronchial manipulations, diagnostic bronchoalveolar lavage, bronchoalveolar fluid.

REFERENCES

1. Oho K., Amemiya R. Practical Fiberoptic Bronchoscopy. 2nd Edn. Tokyo: Igaky-Shoin, 1984. 156 r.
2. Filippov V.P., Chernichenko N.V. Bronkhoskopiya pri zabolevaniyakh legkikh [Bronchoscopy for lung diseases]. Moscow: BINOM, 2014. 184 p.
3. Crystal R.G., Reynolds H.Y., Kalica A.R. Bronchoalveolar lavage. Chest, 1982, Vol. 90, pp. 122–131.
4. Ovchinnikov A.A. Therapeutic possibilities of bronchoscopy for lung diseases. Atmosfera: pul’monologiya i allergologiya, 2005, no. 4, pp. 15–19 (in Russ.).
5. Samsonova M.V. Diagnostic capabilities of bronchoalveolar lavage. Atmosfera: pul’monologiya i allergologiya, 2006, no. 4, pp. 8–12 (in Russ.).
6. Meyer K.C. Bronchoalveolar Lavage as a Diagnostic Tool. Semin. Respir. Crit. Care Med, 2007, vol. 28 (5), pp. 546–560.
7. Shteyner M.L. Additional diagnostic endobronchial manipulations: bronchoalveolar lavage. Zhurnal glavnogo vracha, 2017, no. 6 (24), pp. 26–38 (in Russ.).
8. Beloborodov V.B. Practical guidelines for the diagnosis and treatment of nosocomial pneumonia: what’s new? Infektsii i antimikrobnaya terapiya, 2005, vol. 7, no. 2, pp. 60–66 (in Russ.).
9. Chung H.S., Lee J.H. Bronchoscopic assessment of the evolution of endobronchial tuberculosis. Chest, 2000, vol. 117, pp. 385–392.
10. Shteyner M.L., Zhestkov A.V. Regulations for the use of additional diagnostic endobronchial manipulations for the diagnosis of tuberculous lesions in bronchological practice. Prakticheskaya meditsina, 2014, no. 3 (79), pp. 67–70 (in Russ.).
11. Santoso P., Soeroto A.Y., Juniati R. et al. Improving Diagnostic of Pulmonary Tuberculosis in HIV Patients by Bronchoscopy: A Cross Sectional Study. HIV AIDS (Auckl), 2018, vol. 10, pp. 115–123.
12. Torres A., El-Ebiary M.Invasive diagnostic technigues for pneumonia: protected specimen brush, bronchoalveolar lavage, and lung biopsy methods. Infect. Dis. Clin. North Amer, 1998, vol. 12, pp. 701–722.
13. Paganin F., Lilienthal F., Bourdin A. Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor. Eur. Respir. J, 2004, vol. 24, rr. 779–785.
14. Ranzani O.T., Senussi T., Idone F. et al. Invasive and non-invasive diagnostic approaches for microbiological diagnosis of hospital-acquired pneumonia. Crit. Care, 2019, vol. 23 (1), r. 51.
15. Mulshine J.L., Smith R.A. Lung cancer: screening and early diagnosis of lung cancer. Thorax, 2002, vol. 57, rr. 1071–1078.
16. Poletti V., Poletti G., Murer B. et al. Bronchoalveolar lavage in malignancy. Semin. Respir. Crit. Care Med, 2007, vol. 28 (5), rr. 534–545.
17. Osińska I., Domagała-Kulawik J. Płukanie oskrzelowo-pęcherzykowe w raku płuca-znaczenie w diagnostyce i ocenie odpowiedzi układu odpornościowego [Bronchoalveolar lavage in lung cancer-diagnostic value and assessment of the anti-cancer immune response]. Postepy Hig. Med. Dosw (Online), 2013, vol. 67, rr. 1119–1127.
18. Meyer K.C. The role of bronchoalveolar lavage in interstitial lung disease. Clin. Chest Med, 2004, vol. 25, rr. 637–649.
19. Wells A.U. The clinical utility of bronchoalveolar lavage in diffuse parenchymal lung disease. Eur. Respir. Rev, 2010, vol. 19, rr. 237–241.
20. Mlika M., Ben Kilani M., Berraies A., Braham E., Hamzaoui A., Mezni F. Diagnostic Value of the Bronchoalveolar Lavage in Interstitial Lung Disease. Tunis Med, 2016, vol. 94 (5), rr. 375–384.
21. Palamarchuk G.F., Akopov A.L., Arsen’ev A.I. et al. Bronkhoskopiya v diagnostike i lechenii zabolevaniy organov dykhaniya [Bronchoscopy in the diagnosis and treatment of respiratory diseases]. Saint Petersburg, Izdatel’stvo: «Foliant», 2019. 328 p.
22. Shteyner M.L. The need for a visual assessment of bronchoalveolar fluid. Izvestiya vysshikh uchebnykh zavedeniy. Povolzhskiy region. Meditsinskie nauki, 2016, no. 2 (38), pp. 11–16 (in Russ.).
23. Shteyner M.L., Blashentseva S.A., Zhestkov A.V. et al. Some aspects of diagnostics of lung diseases. Fundamental’nye issledovaniya, 2011, no. 9, part I, pp. 163–169 (in Russ.).
24. Shteyner M.L. Udostoverenie na ratsionalizatorskoe predlozhenie no. 152 ot 26.04.2011 «Sposob povysheniya diagnosticheskoy effektivnosti fibrobronkhoskopii». Prinyato GOU VPO «Samarskiy gosudarstvennyy meditsinskiy universitet» Ministerstva zdravookhraneniya i sotsial’nogo razvitiya RF k ispol’zovaniyu 11.05.2011 [Certificate for the rationalization proposal No. 152 of 04/26/2011 «A way to increase the diagnostic efficiency of fibrobronchoscopy». Accepted by GOU VPO «Samara State Medical University» of the Ministry of Health and Social Development of the Russian Federation for use on 05/11/2011].
25. Shteyner M.L., Zhestkov A.V., Biktagirov Yu.I., Podtyazhkina L.F., Lavrent’eva N.E. Udostoverenie na ratsionalizatorskoe predlozhenie no. 330 ot 30.10.2015 «Sposob vizual’noy otsenki bronkhoal’veolyarnoy zhidkosti». Prinyato GBOU VPO «Samarskiy gosudarstvennyy meditsinskiy universitet» Ministerstva zdravookhraneniya RF k ispol’zovaniyu 11.11.2015 [Certificate for a rationalization proposal No. 330 dated 30.10.2015 «Method for visual assessment of bronchoalveolar fluid». Accepted by the Samara State Medical University of the Ministry of Health of the Russian Federation for use on 11.11.2015].