title: Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: prospective multicenter data.
abstract: 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.
authors: Intensive Care Unit, Saint-Louis Teaching Hospital, Paris, France. elie.azoulay@sls.ap-hop-paris.fr
authors: Elie
authors: E
authors: Azoulay
authors: Djamel
authors: D
authors: Mokart
authors: Antoine
authors: A
authors: Rabbat
authors: Frédéric
authors: F
authors: Pene
authors: Achille
authors: A
authors: Kouatchet
authors: Fabrice
authors: F
authors: Bruneel
authors: François
authors: F
authors: Vincent
authors: Rebecca
authors: R
authors: Hamidfar
authors: Delphine
authors: D
authors: Moreau
authors: Ismaël
authors: I
authors: Mohammedi
authors: Geraldine
authors: G
authors: Epinette
authors: Gaëtan
authors: G
authors: Beduneau
authors: Vincent
authors: V
authors: Castelain
authors: Arnaud
authors: A
authors: de Lassence
authors: Didier
authors: D
authors: Gruson
authors: Virginie
authors: V
authors: Lemiale
authors: Benoît
authors: B
authors: Renard
authors: Sylvie
authors: S
authors: Chevret
authors: Benoît
authors: B
authors: Schlemmer
mesh_terms: 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