Utility of fiberoptic bronchoscopy in neutropenic patients admitted to the intensive care unit with pulmonary infiltrates.
OBJECTIVE
To analyze the impact of fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) on guiding the treatment and intensive care unit (ICU) clinical outcome in neutropenic patients with pulmonary infiltrates admitted to the ICU.


METHODS
Prospective collection of data.


METHODS
Medical ICU in a teaching hospital.


METHODS
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 = 52]).


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 if 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.
Division of Medical Intensive Care, University Hospital, Bordeaux, France.
D
D
Gruson
G
G
Hilbert
R
R
Valentino
F
F
Vargas
G
G
Chene
C
C
Bebear
A
A
Allery
A
A
Pigneux
G
G
Gbikpi-Benissan
J P
JP
Cardinaud
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D005336:Fiber Optic Technology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007958:Leukocyte Count; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D009503:Neutropenia / Q000150:complications* / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents