Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy

Philippe R. Bauer, Sylvie Chevret, Hemang Yadav, Sangeeta Mehta, Peter Pickkers, Ramin B. Bukan, Jordi Rello, Andry van de Louw, Kada Klouche, Anne-Pascale Meert, Ignacio Martin-Loeches, Brian Marsh, Lorenzo Socias Crespi, Gabriel Moreno-Gonzalez, Nina Buchtele, Karin Amrein, Martin Balik, Massimo Antonelli, Martine Nyunga, Andreas Barratt-DueDennis C. J. J. Bergmans, Angélique M. E. Spoelstra-de Man, Anne Kuitunen, Florent Wallet, Amelie Seguin, Victoria Metaxa, Virginie Lemiale, Gaston Burghi, Alexandre Demoule, Thomas Karvunidis, Antonella Cotoia, P. l Klepstad, Ann M. Møller, Djamel Mokart, Elie Azoulay, Efraim investigators and the Nine-I study group

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain. PATIENTS AND METHODS: This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching. RESULTS: Bronchoscopy was performed in 618 (39%) patients who were more likely to have haematological malignancy and a higher severity of illness score. Bronchoscopy alone achieved a diagnosis in 165 patients (27% adjusted diagnostic yield). Bronchoscopy resulted in a management change in 236 patients (38% therapeutic yield). Bronchoscopy was associated with worsening of respiratory status in 69 (11%) patients. Bronchoscopy was associated with higher ICU (40% versus 28%; p<0.0001) and hospital mortality (49% versus 41%; p=0.003). The overall rate of undiagnosed causes was 13%. After propensity score matching, bronchoscopy remained associated with increased risk of hospital mortality (OR 1.41, 95% CI 1.08-1.81). CONCLUSIONS: Bronchoscopy was associated with improved diagnosis and changes in management, but also increased hospital mortality. Balancing risk and benefit in individualised cases should be investigated further.
Original languageEnglish
JournalEuropean Respiratory Journal
Volume54
Issue number1
DOIs
Publication statusPublished - 1 Jul 2019

Cite this

Bauer, P. R., Chevret, S., Yadav, H., Mehta, S., Pickkers, P., Bukan, R. B., ... Efraim investigators and the Nine-I study group (2019). Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy. European Respiratory Journal, 54(1). https://doi.org/10.1183/13993003.02442-2018