Utility of bronchoalveolar lavage for COVID-19: a perspective from the
Dragon consortium.
Abstract
Diagnosing COVID-19 and treating its complications remains a challenge.
This review reflects the perspective of some of the Dragon (IMI 2-call
21, #101005122) research consortium collaborators on the utility of
bronchoalveolar lavage (BAL) in COVID-19. BAL has been proposed as a
potentially useful diagnostic tool to increase COVID-19 diagnosis
sensitivity. In both critically ill and non-critically ill COVID-19
patients, BAL has a relevant role in detecting other infections or in
supporting alternative diagnosis, and can change management decisions in
up to two-third of patients. BAL is used to guide steroid and
immunosuppressive treatment and to narrow or discontinue antibiotic
treatment reducing the use of unnecessary broad antibiotics. Moreover,
cellular analysis and novel multi-omics techniques on BAL are of
critical importance for the understanding of the microenvironment and
interaction between epithelial cells and immunity revealing novel
potential prognostic and therapeutic targets. The BAL technique has been
described as safe for both patients and health care workers in more than
a thousand procedures reported to date in the literature. Based on these
preliminary studies, we recognize that BAL is a feasible procedure in
COVID-19 known or suspected cases, useful to properly guide patient
management and with great potential for research.