Utility of fiberoptic bronchoscopy in neutropenic patients admitted to the intensive care unit with pulmonary infiltrates

被引:77
作者
Gruson, D [1 ]
Hilbert, G
Valentino, R
Vargas, F
Chene, G
Bebear, C
Allery, A
Pigneux, A
Gbikpi-Benissan, G
Cardinaud, JP
机构
[1] Univ Hosp, Div Med Intens Care, Bordeaux, France
[2] Univ Hosp, Bacteriol Lab, Bordeaux, France
[3] Univ Hosp, Dept Hematol, Bordeaux, France
关键词
neutropenia; pneumonia; fever; acute lung injury; intensive care unit; bronchoalveolar lavage; pulmonary infiltrates; hematologic malignancy; bone marrow transplantation; chemotherapy;
D O I
10.1097/00003246-200007000-00007
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To analyze the impact of fiberoptic bronchoscopy and bronchoalveolar ravage (BAL) on guiding the treatment and intensive care unit (ICU) clinical outcome in neutropenic patients with pulmonary infiltrates admitted to the ICU. Design: Prospective collection of data. Setting: Medical ICU in a teaching hospital. Patients: During a 6-yr period, we analyzed the results of 93 fiberoptic bronchoscopies plus BALs performed in 93 consecutive neutropenic ICU patients. We separated the patients into two groups according to the cause of neutropenia (high-dose chemotherapy [n = 41] or stem cell transplantation [SCT; n = 521]). Results: Of the 93 BALs, 53 were performed to evaluate diffuse infiltrates and 42 were performed on mechanically ventilated patients. Forty-nine percent of BALs (46 patients) were diagnostic, with a significantly better yield in ICU patients with high-dose chemotherapy-induced neutropenia (26 of 41 BALs). The number of cases of proven infectious pneumonia was significantly higher in this group of ICU neutropenic patients. In patients who underwent SCT, diffuse infiltrates were statistically correlated with a negative result of BAL. Twenty-six patients who underwent diagnostic BALs changed therapy. Sixteen complications (17%) occurred with only two intubations, The overall mortality rate in the ICU and the mortality rate in mechanically ventilated neutropenic patients were 71% and 93%, respectively. In neutropenic patients who underwent SCT, the mortality rate was statistically higher in patients in whom no diagnosis was established. Patients who had a diagnostic BAL that changed therapy did not have an increased probability of survival compared with patients who had a BAL that did not change therapy. Conclusions:The use of routine diagnostic BAL in ICU neutropenic patients with pulmonary infiltrates is difficult to establish, even ii BAL is helpful in the management of these critically ill patients. BAL in our ICU neutropenic patient population had an acceptable overall diagnostic yield (49%), which was higher in ICU patients with chemotherapy-induced neutropenia. Nevertheless, in the ICU, if BAL had a low complication rate, it had infrequently led to changed treatment and was not associated with improved patient survival.
引用
收藏
页码:2224 / 2230
页数:7
相关论文
共 33 条
  • [1] ABUFARSAKH HAA, 1995, ACTA CYTOL, V39, P1081
  • [2] ACUTE HYPOXEMIC RESPIRATORY-FAILURE IN CHILDREN FOLLOWING BONE-MARROW TRANSPLANTATION - AN OUTCOME AND PATHOLOGICAL-STUDY
    BOJKO, T
    NOTTERMAN, DA
    GREENWALD, BM
    DEBRUIN, WJ
    MAGID, MS
    GODWIN, T
    [J]. CRITICAL CARE MEDICINE, 1995, 23 (04) : 755 - 759
  • [3] BREUER R, 1993, RESP MED, V87, P571
  • [4] INVESTIGATION AND MANAGEMENT OF PULMONARY-INFILTRATES FOLLOWING BONE-MARROW TRANSPLANTATION - A 8 YEAR REVIEW
    CAMPBELL, JH
    BLESSING, N
    BURNETT, AK
    STEVENSON, RD
    [J]. THORAX, 1993, 48 (12) : 1248 - 1251
  • [5] CORDONNIER C, 1985, AM REV RESPIR DIS, V132, P1118
  • [6] CORDONNIER C, 1986, CANCER, V58, P1047, DOI 10.1002/1097-0142(19860901)58:5<1047::AID-CNCR2820580512>3.0.CO
  • [7] 2-Y
  • [8] BRONCHOALVEOLAR LAVAGE DURING NEUTROPENIC EPISODES - DIAGNOSTIC YIELD AND CELLULAR-PATTERN
    CORDONNIER, C
    ESCUDIER, E
    VERRA, F
    BROCHARD, L
    BERNAUDIN, JF
    FLEURYFEITH, J
    [J]. EUROPEAN RESPIRATORY JOURNAL, 1994, 7 (01) : 114 - 120
  • [9] OPEN LUNG-BIOPSY DIAGNOSIS OF DIFFUSE PULMONARY-INFILTRATES AFTER MARROW TRANSPLANTATION
    CRAWFORD, SW
    HACKMAN, RC
    CLARK, JG
    [J]. CHEST, 1988, 94 (05) : 949 - 953
  • [10] THE EFFECT OF ANTIBIOTIC-THERAPY ON RECOVERY OF INTRACELLULAR BACTERIA FROM BRONCHOALVEOLAR LAVAGE IN SUSPECTED VENTILATOR-ASSOCIATED NOSOCOMIAL PNEUMONIA
    DOTSON, RG
    PINGLETON, SK
    [J]. CHEST, 1993, 103 (02) : 541 - 546