[Bronchoscopy in the diagnosis of diffuse pulmonary infiltrates, and corticosteroid treatment in patients with acute respiratory failure].

Forty patients with acute respiratory failure underwent fiberoptic bronchoscopy for evaluation of diffuse pulmonary infiltrates. Immunohematological diseases were the commonest underlying conditions; they were present in 48% of patients. Twenty-five percent of patients had pulmonary disease. Fiberoptic bronchoscopy was done 2.2 days after confirmation of the pulmonary lesion. Seventy-three percent of patients had already received antibiotics and 28% required mechanical ventilation at the time of fiberoptic bronchoscopy. Arterial blood gas analysis done just before fiberoptic bronchoscopy revealed that PaO2 and PaCO2 were 62 Torr and 36 Torr, respectively. A specific diagnosis was made in 29 patients (73%): pneumonia in 13; pulmonary fibrosis in 4; summer-type hypersensitivity pneumonitis in 3; and leukemic cell infiltration in 2. Fifty-two percent of patients were successfully treated with specific therapy. The complications of fiberoptic bronchoscopy were bleeding in 3 patients, pneumothorax in 3 patients, and exacerbation of respiratory failure in one patient. There were no procedure-related deaths, and fiberoptic bronchoscopy was judged to be safe and useful in the diagnosis of pulmonary infiltrates in patients with acute respiratory failure. Twenty-five patients (68%) received high doses of methylprednisolone. The average initial dose was 851 +/- 373 mg, and more than 100 mg was administered for 8 +/- 6 days. Seventeen of these patients recovered from the pulmonary disease. A controlled randomized study is needed to reevaluate the role of corticosteroids in the treatment of acute respiratory distress syndrome.