REVIEW   

Minerva Respiratory Medicine 2022 December;61(4):189-97

DOI: 10.23736/S2784-8477.22.02037-X

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

The role of bronchoalveolar lavage in diagnosis and prognosis of COVID-19 patients

Filippo PATRUCCO ^{1, 2} ✉, Francesco GAVELLI ^{2, 3}, Piero P. SAINAGHI ^{2, 4}, Michele MONDONI ^{5, 6}, Mattia BELLAN ^{2, 4}, Simona PRIORA ³, Valentina GIAI VIA ³, Martina ZAVA ¹, Gian C. AVANZI ^{2, 3}, Rosanna VASCHETTO ^{2, 7}, Piero E. BALBO ¹, Paolo SOLIDORO ^{4, 5}

¹ Unit of Respiratory Diseases, Medical Department, AOU Maggiore della Carità, Novara, Italy; ² Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; ³ Department of Emergency Medicine, AOU Maggiore della Carità, Novara, Italy; ⁴ Unit of Internal Medicine, Medical Department, AOU Maggiore della Carità, Novara, Italy; ⁵ Unit of Pulmonology, Cardio-Respiratory Department, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy; ⁶ Department of Health Sciences, University of Milan, Milan, Italy; ⁷ Intensive Care Unit, Emergency Department, AOU Maggiore della Carità, Novara, Italy

SARS-CoV-2 infection diagnosis is mainly based on nasopharyngeal swab real-time reverse-transcriptase-polymerase reaction positivity in the presence of clinical and radiological suspicion of viral infection. In case of negative test, bronchoscopy with bronchoalveolar lavage (BAL) is the most used technique to rule out SARS-CoV-2 infection. The role of BAL in COVID-19 diagnosis is debated since its diagnostic yield is highly influenced by several factors. Nevertheless, the analysis of BAL fluid provides many important information about the COVID-19 alveolar environment. The analysis of alveolar populations, as well as cytokines and chemokine production, may contribute to better understand the pathogenetic mechanisms involved in COVID-19, providing information on patients’ prognosis. Moreover, many efforts have been spent on transcriptome analysis of host response to SARS-CoV-2 infection. In this narrative review we explored the role of BAL in diagnosis and prognosis of patients with COVID-19, focusing on its diagnostic yield, on its role in the study of alveolar cytology, cytokines and chemokines production, microbiological coinfection and how they can influence the prognosis of COVID-19 patients.

KEY WORDS: SARS-CoV-2; COVID-19; Bronchoscopy; Bronchoalveolar lavage; Prognosis