Cardiopulmonary decompensation during repeated bronchial-alveolar lavage(BAL) sampling is of both technical and clinical concern. The pathophysiologic, hemodynamic and pulmonary function changes were evaluated in 25 bedside studies of 13 VLBW infants (mean±SD: GA = 26.0±2.8wks, BW = 780±284g, study weight = 1037±263g). The protocol for BAL consisted of: increasing the FiO2 20%, disconnecting the infant from the ventilator, instilling 0.5cc saline irrigant into the ET tube, suctioning any secretions, and reconnecting to the ventilator. The effects of 3-4 sequential BAL procedures were studied.Results: Each BAL was seldom associated with bradycardia (HR < 80/min) but usually with desaturation (SpO2 < 90%) and stabilization to near baseline levels occurred within 60 to 120 sec. The mean ± SEM percent changes from baseline after successive suctions for some cardio-respiratory parameters are as follows: Table The initial samplings (#1-#2) are associated with significant hemodynamic and pulmonary compromise (**p<0.001,*p<0.05). The initial decompensation was followed by a significant reduction in pulmonary resistance after BAL (13.8% from baseline values, p<0.05). In 7 infants there were no significant changes in function residual capacity lung compliance, blood gas or systemic blood pressure after serial BAL. These data suggest that appropriate adherence to BAL protocol is associated with initial but no progressive deleterious effects such that the infants may tolerate third and fourth serial samplings.
