Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York.
Ann Am Thorac Soc. 2013 Feb;10(1):39-49. doi: 10.1513/AnnalsATS.201212-114FR.
Fiberoptic bronchoscopy is a valuable diagnostic tool in solid-organ and hematopoietic stem cell transplant recipients presenting with a range of pulmonary complications. This article provides a comprehensive overview of the utility and potential adverse effects of diagnostic bronchoscopy for transplant recipients. Recommendations are offered on the selection of patients, the timing of bronchoscopy, and the samples to be obtained across the spectrum of suspected pulmonary complications of transplantation. Based on review of the literature, the authors recommend early diagnostic bronchoscopy over empiric treatment in transplant recipients with evidence of certain acute, subacute, or chronic pulmonary processes. This approach may be most critical when an underlying infectious etiology is suspected. In the absence of prompt diagnostic information on which to base effective treatment, the risks associated with empiric antimicrobial therapy, including medication side effects and the development of antibiotic resistance, compound the potential harm of delaying targeted management.
纤维支气管镜检查在患有各种肺部并发症的实体器官和造血干细胞移植受者中是一种有价值的诊断工具。本文全面概述了诊断性支气管镜检查在移植受者中的应用和潜在不良影响。就疑似移植后肺部并发症的患者选择、支气管镜检查的时机以及获得的样本提出了建议。基于文献回顾，作者建议在有某些急性、亚急性或慢性肺部过程证据的移植受者中，早期进行诊断性支气管镜检查，而不是经验性治疗。当怀疑潜在感染病因时，这种方法可能最为关键。在缺乏基于有效治疗的快速诊断信息的情况下，经验性抗菌治疗相关的风险，包括药物副作用和抗生素耐药性的发展，使延迟靶向治疗的潜在危害进一步增加。
