[Safety aspects of bronchoalveolar lavage in risk patients in childhood--continuous end-expiratory pCO2 monitoring].

Although bronchoalveolar lavage (BAL) is a useful tool even in childhood pulmonary diseases, only little is known about the problems attendant to its use. Hence, we investigated from a total of 212 rigid bronchoscopy procedures 22 patients of 1-10 years of age. General inhalation anaesthesia was performed and BAL was carried out using a paediatric standardised protocol. BAL volume was adjusted to body weight. Before BAL and 2, 7 and 20 minutes after BAL capillary blood gas, blood pressure, heart rate and SaO2 were measured. Continuously end-tidal PCO2 (ET (PCO2) measurement was done by using a catheter placed in the main stream bronchus. Mean ET PCO2 increased from 39.6 +/- 9.5 mmHg to 45.7 +/- 6.87 mmHg. Concomitantly mean capillary PCO2 increased from 46.68 +/- 10.7 mmHg to 50.1 +/- 10.47 mmHg. Correlation of ET PCO2 compared to cap PCO2 was good (r = 0.89). One patient showed desaturation up to 72% another patient hypercapnia up to 77 mmHg. We conclude that generally speaking BAL is a safe procedure, even in high-risk patients. Complications are minor and of little consequence to the patient. However, severe unforeseen events may occur. Therefore, bronchoscopy and bronchoalveolar lavage should not be performed without availability of an intensive-care unit.