Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: prospective multicenter data.
OBJECTIVE
To describe the diagnostic yields of test strategies with and without fiberoptic bronchoscopy and bronchoalveolar lavage (FO-BAL), as well as outcomes, in cancer patients with acute respiratory failure (ARF).


METHODS
Prospective observational study.


METHODS
Fifteen intensive care units in France.


METHODS
In all, 148 cancer patients, including 45 bone marrow transplant recipients (27 allogeneic, 18 autologous) with hypoxemic ARF.


METHODS
None.


RESULTS
Overall, 146 causes of ARF were identified in 128 patients (97 [66.4%] pulmonary infections). The cause of ARF was identified in 50.5% of the 101 patients who underwent FO-BAL and in 66.7% of the other patients. FO-BAL was the only conclusive test in 34 (33.7%) of the 101 investigated patients. Respiratory status deterioration after FO-BAL occurred in 22 of 45 (48.9%) nonintubated patients, including 16 (35.5%) patients who required ventilatory support. Hospital mortality was 55.4% (82 deaths) overall and was not significantly different in the groups with and without FO-BAL. By multivariate analysis, mortality was affected by characteristics of the malignancy (remission, allogeneic bone marrow transplantation), cause of ARF (ARF during neutropenia recovery, cause not identified), and need for life-sustaining treatments (mechanical ventilation and vasopressors).


CONCLUSIONS
In critically ill cancer patients with ARF, a diagnostic strategy that does not include FO-BAL may be as effective as FO-BAL without exposing the patients to respiratory status deterioration.
Azoulay
Elie
E
Intensive Care Unit, Saint-Louis Teaching Hospital, Paris, France. elie.azoulay@sls.ap-hop-paris.fr
Mokart
Djamel
D
Rabbat
Antoine
A
Pene
Frédéric
F
Kouatchet
Achille
A
Bruneel
Fabrice
F
Vincent
François
F
Hamidfar
Rebecca
R
Moreau
Delphine
D
Mohammedi
Ismaël
I
Epinette
Geraldine
G
Beduneau
Gaëtan
G
Castelain
Vincent
V
de Lassence
Arnaud
A
Gruson
Didier
D
Lemiale
Virginie
V
Renard
Benoît
B
Chevret
Sylvie
S
Schlemmer
Benoît
B
D000208:Acute Disease; D000368:Aged; D018893:Bronchoalveolar Lavage / Q000706:statistics & numerical data; D001999:Bronchoscopy / Q000706:statistics & numerical data*; D015984:Causality; D005260:Female; D005602:France / Q000453:epidemiology; D006402:Hematologic Diseases / Q000150:complications*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors