Fiberoptic bronchoscopy and bronchoalveolar lavage (BAL)
Fiberoptic bronchoscopy was performed in sedation, with the patient spontaneously breathing but ventilation was assisted manually, when needed. The video bronchoscopes (Olympus BF-XP190, BF-3C160 or BF-P190) were introduced through a face mask in a nostril, as described elsewhere [3]. The presence and the characteristics of tracheal narrowing, in inspiration and expiration or during cough, was evaluated during bronchoscopy and reassessed playing back the session videotape. BAL was performed by injecting 3×1 ml/kg body weight aliquots of sterile saline solution, which were aspirated at a negative pressure of
40mm Hg in siliconized plastic tubes. Samples of BAL fluid was sent to the laboratory for microbiologic and cytologic examination and total and differential cell counts were recorded as described [10]. Bacterial growth was expressed as colony-forming units (CFU)/mL.