Leukemia Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2018 Mar;65(3):272-279. doi: 10.1007/s12630-017-1041-7. Epub 2017 Dec 18.
Flexible bronchoscopy with bronchoalveolar lavage (BAL) is commonly performed in immunocompromised patients. Nevertheless, it remains unclear whether bronchoscopy with BAL leads to changes in medical management or is associated with procedural complications among critically ill acute leukemia (AL) patients.
We evaluated 71 AL patients who underwent diagnostic bronchoscopy with BAL in the intensive care unit (ICU) between 1 January 2007 and 31 December 2012. We recorded baseline characteristics, vital signs (before, during, and after the procedure), changes in medical management following the procedure, and procedural complications. Using a multivariable logistic regression model, we explored the relationship between patient characteristics and whether bronchoscopy changed management or caused complications. Patient characteristics included as predictors in the regression model were age, sex, immunosuppression status (those undergoing active chemotherapy), and the Acute Physiology And Chronic Health Evaluation II score.
The most common indication for ICU admission was respiratory failure (51 patients, 72%), followed by sepsis (14 patients, 20%). Overall, the results obtained from bronchoscopy with BAL were associated with a change in management in 32 patients (45%), most commonly a change in antimicrobial therapy as a result of an infectious pathogen being identified (17 patients, 24%). Complications were documented in nine patients (13%) and included post-procedural hypoxia (six patients, 8%), the need for intubation (one patient, 9% of non-intubated patients), and tracheal perforation (one patient, 1%). No clinically significant changes in patient vital signs were observed during or immediately following the procedure. Patient characteristics did not predict whether bronchoscopy was associated with changes in medical management or procedural complications in multivariable analyses.
Flexible bronchoscopy with BAL is relatively safe and helps to guide medical management among patients with AL admitted to the ICU.
在免疫功能低下的患者中，常进行支气管镜肺泡灌洗（BAL）检查。然而，目前尚不清楚支气管镜检查与 BAL 是否会改变治疗方法，或与危重症急性白血病（AL）患者的操作并发症相关。
我们评估了 2007 年 1 月 1 日至 2012 年 12 月 31 日期间在重症监护病房（ICU）接受诊断性支气管镜检查和 BAL 的 71 例 AL 患者。我们记录了患者的基本特征、生命体征（操作前、操作中和操作后）、操作后治疗方法的改变情况，以及操作并发症。采用多变量逻辑回归模型，探讨患者特征与支气管镜检查改变治疗方法或导致并发症之间的关系。回归模型中纳入的患者特征包括年龄、性别、免疫抑制状态（正在接受积极化疗的患者）和急性生理学和慢性健康评估 II 评分。
入住 ICU 的最常见原因是呼吸衰竭（51 例，72%），其次是败血症（14 例，20%）。总体而言，支气管镜检查和 BAL 的结果与 32 例患者（45%）的治疗方法改变相关，最常见的是由于确定了感染病原体，改变了抗菌治疗（17 例，24%）。9 例患者（13%）出现并发症，包括操作后缺氧（6 例，8%）、需要插管（1 例，非插管患者的 9%）和气管穿孔（1 例，1%）。操作期间或操作后即刻，患者生命体征无明显变化。多变量分析显示，患者特征不能预测支气管镜检查是否与治疗方法改变或操作并发症相关。
支气管镜检查和 BAL 相对安全，有助于指导 ICU 中 AL 患者的治疗。
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