BRONCHOALVEOLAR LAVAGE USING DIFFERENT VOLUMES OF SALINE

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 支气管肺泡灌洗(BAL)是一种通常用于从下呼吸道上皮表面采集细胞和非细胞成分的程序。对下呼吸道内容物进行采样可以更好地了解正常人和各种肺部疾病患者的肺泡上皮衬里液的成分。这一过程不是标准化的，而且可以根据使用的生理盐水灌洗量而有所不同。通常每个站点使用的总体积在100毫升到150毫升之间，总的最大容量不大于300毫升。临床医生和研究人员使用的个人等分体积从20毫升到100毫升不等。冲洗后的放射学改变并不清楚是由于液体滞留，但可能继发于肺表面活性物质丢失导致局限性肺不张。尽管BAL本身通常不会导致全局性的肺功能改变，但它可能会导致肺力学的局部改变。了解灌洗后肺功能正常患者的这些局部变化可能有助于进一步了解肺功能对健康和疾病的影响。 在这项初步研究中，这些研究人员将研究6名将接受BAL支气管镜检查的受试者，在手术前和手术后的不同时间点进行CT扫描。他们将用两种不同体积的生理盐水在每个肺中冲洗一段。他们将使用5x20cc等分和4x50cc等分，这两种药物都已在大量患者中安全使用。他们将检查每等分液体中的细胞计数、差异和表面活性物质水平。将对来自同一肺的连续等分以及每个受试者的肺之间的累积灌洗进行比较。CT扫描将用于确认灌洗的位置，并表征灌洗后肺内的局部变化。它将进一步有助于描述灌洗后这些变化的解决情况。 他们假设，支气管肺泡灌洗会导致一过性肺不张，从而改变肺的局部机械特性。这可以通过CT显示，这些异常与灌洗量和回收的表面活性物质的量呈正相关。他们进一步假设，肺泡过度扩张，使用更大体积的生理盐水，伴随着表面活性物质的丧失，会导致与中性粒细胞和红细胞水平升高相关的轻微局部损伤。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Bronchoalveolar lavage (BAL) is a procedure commonly used for sampling of both cellular and noncellular components from the epithelial surface of the lower respiratory tract. Sampling the contents of the lower respiratory tract has led to a better understanding of components of the alveolar epithelial lining fluid in normal persons and in individuals with a variety of lung diseases. This procedure is not standardized and can vary in terms of the volume of saline lavage used. Usually the total volume used per site is between 100 cc and 150 cc with the total maximum volume being no greater than 300 cc. The volume of individual aliquots used by clinicians and researchers ranges from 20 cc to 100 cc. Radiographic changes have been demonstrated following lavage which are not clearly due to retained fluid, but may be secondary to loss of surfactant leading to localized areas of atelectasis. Though BAL itself does not typically lead to global alterations in lung function, it may lead to localized alterations in lung mechanics. An understanding of these local changes in patients with normal lung function following lavage may provide further insight into lung function in health and disease. For this pilot study, these investigators will study six subjects who will undergo bronchoscopy with BAL, with CT scanning prior to the procedure, and at various time points following the procedure. They will lavage a segment in each lung using two different volumes of saline. They will use 5 x 20 cc aliquots and 4 x 50 cc aliquots, both of which have been used safely in large numbers of patients. They will examine the cell count, differential and surfactant levels in each aliquot of fluid. Comparison of successive aliquots from the same lung as well as the cumulative lavage between lungs within each subject will be done. CT scanning will be used to validate the location of the lavage and to characterize the local changes within the lung following the lavage. It will further assist in characterizing the resolution of those changes following lavage. They hypothesize that bronchoalveolar lavage leads to transient areas of atelectasis which alter the local mechanical properties of the lung. This can be demonstrated by CT and these abnormalities are positively correlated with the volume of lavage used, and the amount of surfactant recovered. They further hypothesize that over distension of the alveoli, using the larger volumes of saline, with loss of surfactant causes mild, local injury associated with increased levels of neutrophils and red blood cells.