Location of bronchoalveolar lavage in children

Background: Bronchoalveolar lavage (BAL) is a useful procedure in the diagnosis and treatment of several respiratory diseases. The right middle lobe or lingula is the preferred location of BAL in diffuse lung disease. The aim of this study was to determine the proper location of BAL in infants and children. Design: This was prospective, observational study at Queen Sirikit National Institute of Child Health between January and December 2017. Materials and Methods: Children, aged 1 month to 15 years, who underwent BAL were enrolled for this study. BAL was performed with the flexible bronchoscope under general anesthesia. The total instilled volume was generally 2–3 ml/kg, divided into 2–6 aliquots. The location of BAL was the most affected area in chest radiography. In diffuse lung disease, BAL was performed in all lobes. The volume and percentage of fluid recovered from various lobes were compared. Statistical Analysis: Statistical analysis was performed using SPSS version 23. The value of P < 0.05 was considered statistically significant. Results: A total of 66 patients with a median age of 1.6 years were enrolled. The total volume recovered was 20% of the instilled volume (interquartile range [IQR] 13.4, 31.8). The volume recovered from the right lung (23%, IQR 13.4, 32.58) was significantly higher than from the left lung (18.9%, IQR 12.5, 30, P = 0.019). There was no significant difference between volume recovered from various lobes. However, there was a trend toward higher volume recovered from the right lower lobe (RLL) (25%, IQR 13.1, 33.75). Conclusions: In infants and children, BAL performed in the right lung and RLL is associated with a higher volume recovered.