Chest
Volume 111, Issue 1, January 1997, Pages 135-141
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Clinical Investigations: Infectious Diseases
Bronchoscopic Evaluation of Pulmonary Infiltrates Following Bone Marrow Transplantation

https://doi.org/10.1378/chest.111.1.135Get rights and content

Study objective

To determine the impact of fiberoptic bronchoscopy (FOB), including quantitative bacterial cultures obtained by BAL and protected specimen brushing on therapeutic decisions and outcome in bone marrow transplant (BMT) patients.

Design

Retrospective review of all BMT patients undergoing FOB during a 4-year period. Setting: A tertiary care university hospital.

Results

Three hundred five patients underwent BMT; 71 (23%) had FOB to assess pulmonary infiltrates. Allogeneic BMT recipients underwent FOB 3.37 times more often than autologous recipients (p<0.001). Pathogens were identified in 31 (46%) patients undergoing FOB; bacteria were most commonly isolated although 86% of patients had received broad-spectrum empiric antibiotics. Therapy was changed in 20 (65%) patients when a microorganism was identified and in 9 (22%) with nondiagnostic results (p=0.0026), but isolation of a presumed pathogen had no apparent effect on survival. There were 19 (27%) FOB complications, including bleeding in 8 (11%) patients and death in 2 (3%). Major complications were associated with prolonged prothrombin time (p=0.006) and were more common (36% vs 14%; p<0.05) in patients who had protected specimen brushing vs BAL alone. Mortality at 40 months in BMT patients not requiring FOB was 33% compared with 61% mortality in those undergoing FOB (p<0.001); mortality was 96% in patients with respiratory failure requiring mechanical ventilation.

Conclusion

FOB is diagnostically useful in the evaluation of some BMT patients with pulmonary complications and often influences therapy, although no impact on survival was clearly demonstrated. FOB should be performed only after benefits of the procedure are weighed carefully against its increased risk in this select population.

Section snippets

Patient Demographics

We retrospectively studied the records of all BMT recipients who underwent FOB between May 1990 (initiation of the BMT program) and September 1994 at the Bowman Gray School of Medicine/Wake Forest University Medical Center and North Carolina Baptist Hospital, Winston-Salem. Patients were identified via hospital discharge coding through the medical records department. Data were obtained by review of all patient charts, bronchoscopy reports, and BMT records.

Laboratory and Chest Radiographic Data

Laboratory data from the day of FOB

Patient Demographics and Laboratory Data

During the period of review, 305 patients underwent BMT, including 224 (73%) receiving autologous and 81 (27%) allogeneic transplants. Of these, 71 patients underwent FOB, of whom 31 (43%) were women and 40 (57%) were men. The mean age of patients undergoing FOB was 38 years (range, 20 to 58 years). The indications for BMT in patients undergoing FOB are summarized in Table 1. The most common underlying condition was non-Hodgkin's lymphoma (28%). Mean±SD results of laboratory data obtained the

DISCUSSION

The spectrum of pulmonary complications and their temporal relationships to BMT have been reviewed extensively.1, 2, 3, 4, 5, 6,8,10,19, 20, 21, 22 Over a 4-year period at our center, 71 (23%) of 305 BMT recipients underwent FOB for the further evaluation of pulmonary infiltrates, a frequency similar to the experience at other centers.16, 19 Allogeneic BMT recipients develop pulmonary complications at a much higher frequency than those receiving autologous BMT. In addition, a greater proportion

ACKNOWLEDGMENT

The authors wish to thank Drs. Norman Adair, Julia Cruz, Robert Chin, and James Perry for their invaluable assistance with review and preparation of the manuscript, and to Tracey Carroll, Sherry Smith, and the Medical Records Staff of North Carolina Baptist Hospital for their assistance with data collection.

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