Utility of fiberoptic bronchoscopy in bone marrow transplant patients

Abstract

Summary:idiopathic noninfectious pneumonia; (3) pulmonary edema (hydrostatic or noncardiogenic); (4) respiratory failure (pulmonary and extrapulmonary etiologies); (5) inflammaFiberoptic bronchoscopy (FOB) has been reported to have a high diagnostic yield and to be safe in BMT tory conditions (diffuse alveolar damage (DAD), bronchiolitis obliterans organizing pneumonia (BOOP), bronchiolitis patients with pulmonary infiltrates. At our institution, BMT patients with respiratory symptoms and/or pulobliterans (BO), and pulmonary graft-versus-host disease); (6) pulmonary hemorrhage; and (7) The use of FOB to evaluate pulmonary infiltrates in BMT patients was not previously standardized at our institution. (15%) occurred in 10 FOBs (five acute respiratory failure, three pneumothoraces, one nose bleed, one death).Although the medical literature indicates that FOB in BMT patients with pulmonary infiltrates is a safe and valuable Hospital and 6-month survival based on episodes of clinical pneumonia were 47 and 32%, respectively. diagnostic procedure, its impact on providing a diagnosis, guiding treatment, and patient outcome at our institution Patients who had a diagnostic FOB or a FOB that changed treatment did not have better hospital or 6-was unclear. A data base was established to collect existing clinical information to assess the yield, impact on treatmonth survival compared to patients who had FOBs that were nondiagnostic or did not change treatment.ment, safety and survival in BMT patients who had FOB to evaluate respiratory symptoms and/or pulmonary infiltrates. FOB in our BMT patient population, had a low diagnostic yield (31%), infrequently changed treatment (24%), a significant complication rate (15%) and was not associated with improved patient survival. The role of rouMaterials and methods tine diagnostic FOB in BMT patients with pulmonary infiltrates and/or respiratory symptoms should be rePatient population evaluated.

Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

“…In these patients, reported diagnostic yields range from 35 to 60%. 8,9,11,12,15,17,[18][19][20][21][22][23][24] We found comparable results in our patients with lymphoid malignancies, with a diagnostic yield of 50%. The much lower diagnostic yield of FOB-BAL in our AML patients with ARF admitted in ICU raises several issues, dominated by the differences in studied populations between available reports.…”

Utility of early versus late fiberoptic bronchoscopy in the evaluation of new pulmonary infiltrates following hematopoietic stem cell transplantation

“…1,9,10,13,15,16,20 Our study suggests that the timing of FOB is another critical factor and that the yield of the procedure wanes with elapsed time following clinical presentation. Our overall yield of 55% is notable in light of the near universal administration of antimicrobial therapy following HSCT, which may diminish the sensitivity and specificity of bronchoscopically obtained cultures.…”

“…[6][7][8] The diagnostic yield of FOB in the immunocompromised host is variable (31-80%), and consensus regarding its utility in guiding therapeutic decisions and influencing outcomes-even when a likely pathogen is recovered-is lacking. 5,[9][10][11][12][13][14][15][16] Additionally, FOB-related complication rates in the post transplant setting exceeding 20% in some studies have increased skepticism for this procedure. 1,17 We hypothesized that the low diagnostic yields of post transplant FOB correlate with the duration of previous empiric antimicrobial therapy and delays in referrals for the procedure.…”

The clinical importance of bronchoalveolar lavage in allogeneic SCT patients with pneumonia

“…was high compared with some previous studies with diagnostic yields between 31 and 49%. 5,8,22,23 Other studies have shown diagnostic yields of 51-80%. 3,19,[24][25][26] In total, 7 BALs were performed in children and contributed to the diagnosis in four of these.…”

“…3,6 In previous studies, however, the reported diagnostic yield has been highly variable and the identification of a pathogen using bronchoscopy does not seem to influence mortality. 7,8 In this study, we evaluated the incidence, etiology and outcome of pneumonia, and the safety and value of BAL for establishing the diagnosis in patients transplanted at the Karolinska University Hospital, Stockholm.…”