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Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: Prospective multicenter data*

Azoulay, Elie MD, PhD; Mokart, Djamel MD; Rabbat, Antoine MD; Pene, Frédéric MD; Kouatchet, Achille MD; Bruneel, Fabrice MD; Vincent, François MD; Hamidfar, Rebecca MD; Moreau, Delphine MD; Mohammedi, Ismaël MD; Epinette, Geraldine MS; Beduneau, Gaëtan MD; Castelain, Vincent MD; de Lassence, Arnaud MD; Gruson, Didier MD; Lemiale, Virginie MD; Renard, Benoît MD; Chevret, Sylvie MD, PhD; Schlemmer, Benoît MD

doi: 10.1097/01.CCM.0000295590.33145.C4
Clinical Investigations
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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).

Design: Prospective observational study.

Setting: Fifteen intensive care units in France.

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

Intervention: 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).

Conclusion: 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.

From the Intensive Care Unit (EA, GE, BS) and Biostatistics Department (SC) of Saint-Louis Teaching Hospital, the Respiratory Critical Care Unit of Hôtel-Dieu Hospital (AR), and Paris 5 (AR, FP, VL), 7 (EA, AdL, SC, GE, BS), and 11 (FV) Universities, Paris, France; the Polyvalent Intensive Care Unit, Institut Paoli Calmette, Marseille, France (DjM); the intensive care units of the hospitals and universities of Angers (AK), Lyon (IM), Rouen (GB), Strasbourg (VC), and Bordeaux (DG), France; the intensive care units of the hospitals of Cochin (FP, VL), Versailles (FB), Avicenne (FV), Michallon (RH), and Roche-sur-Yon (BR), France; Grenoble University (RH), Grenoble, France; Polyvalent Intensive Care Unit, Institut Gustave Roussy, Villejuif, France (DeM); and the Intensive Care Unit, Louis Mourier Hospital, Colombes, France (AdL).

†Deceased.

Supported, in part, by grant AOM 04139 from the Assistance-Publique Hôpitaux de Paris.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: elie.azoulay@sls.ap-hop-paris.fr

© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins