The Diagnostic Yield, Safety, and Impact of Flexible Bronchoscopy in Non-HIV Immunocompromised Critically Ill Patients in the Intensive Care Unit
| Autor: | Steve G. Peters, Mazen O. Al-Qadi, Rodrigo Cartin-Ceba, Sumanjit Kaur, Rahul Kashyap |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Graft Rejection
Lung Diseases Male Bronchoalveolar lavage Pulmonary and Respiratory Medicine medicine.medical_specialty Critical Illness Clinical Decision-Making Pneumonia Viral Hemorrhage Disease Hypoxemia law.invention Immunocompromised Host 03 medical and health sciences 0302 clinical medicine Bronchoscopy law Intensive care Pneumonia Bacterial medicine Humans Hospital Mortality Prospective Studies Intensive care medicine Immunocompromised Aged Lung medicine.diagnostic_test business.industry Middle Aged Intensive care unit 3. Good health Intensive Care Units Critical care medicine.anatomical_structure 030228 respiratory system 030220 oncology & carcinogenesis Female Observational study Pulmonary Aspergillosis medicine.symptom business Bronchoalveolar Lavage Fluid Lung Transplantation |
| Zdroj: | Lung |
| ISSN: | 1432-1750 0341-2040 |
| Popis: | Background Flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) have major roles in the evaluation of parenchymal lung diseases in immunocompromised patients. Given the limited evidence, lack of standardized practice, and variable perception of procedural safety, uncertainty still exists on what constitutes the best approach in critically ill patients with immunocompromised state who present with pulmonary infiltrates in the era of prophylactic antimicrobials and the presence of new diagnostic tests. Objective To evaluate the diagnostic yield, safety and impact of FB and BAL on management decisions in immunocompromised critically ill patients admitted to the intensive care unit (ICU). Methods A prospective, observational study of 106 non-HIV immunocompromised patients admitted to the intensive care unit with pulmonary infiltrates who underwent FB with BAL. Results FB and BAL established the diagnosis in 38 (33%) of cases, and had a positive impact on management in 44 (38.3%) of cases. Escalation of ventilator support was not required in 94 (81.7%) of cases, while 18 (15.7%) required invasive and 3 (2.6%) required non-invasive positive pressure ventilation after the procedure. Three patients (2.6%) died within 24 h of bronchoscopy, and 46 patients (40%) died in ICU. Significant hypoxemia developed in 5% of cases. Conclusion FB can be safely performed in immunocompromised critically ill patients in the ICU. The yield can be improved when FB is done prior to initiation of empiric antimicrobials, within 24 h of admission to the ICU, and in patients with focal disease. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink