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Bronchoscopy in immunocompromised host with pulmonary infiltrates
1Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
Annals of the Academy of Medicine, Singapore
|November 1, 1996
Summary
Early bronchoscopy in immunocompromised hosts (ICH) with pulmonary infiltrates offers a high diagnostic yield. Prompt procedures improve patient outcomes, reduce antimicrobial use, and shorten hospital stays.
Area of Science:
- Pulmonology
- Infectious Diseases
- Oncology
Background:
- Pulmonary complications in immunocompromised hosts (ICH) are diverse, including infection, neoplasia, and treatment toxicity.
- The diagnostic value and optimal timing of bronchoscopy in ICH with pulmonary infiltrates are not well-established.
- Bronchoscopic procedures in ICH can be challenging due to varying yields and uncertain indications.
Purpose of the Study:
- To prospectively evaluate the diagnostic yield and impact of early versus delayed bronchoscopy in immunocompromised hosts with pulmonary lesions.
- To compare outcomes, including diagnostic yield, complication rates, antimicrobial use, and hospitalisation duration, between early and delayed bronchoscopy groups.
- To determine the optimal timing for bronchoscopic intervention in ICH presenting with pulmonary infiltrates.
Main Methods:
- A prospective study of 60 consecutive ICH with pulmonary lesions over 12 months.
- Patients were divided into early (E, n=40) and late (L, n=20) bronchoscopy groups, performed within 72 hours or after 16.7 days of antimicrobial treatment, respectively.
- Procedures included bronchoalveolar lavage, bronchial and lung biopsies, brushing, and washing, with diagnostic yields assessed for fluid and tissue samples.
Main Results:
- Combined fluid and tissue analysis yielded a diagnostic rate of approximately 70% in both early and late groups.
- Infections comprised about two-thirds of the pulmonary lesions.
- Early bronchoscopy was associated with reduced empirical antimicrobial therapy and shorter hospitalisation durations.
- Procedural complications were minor (13%), with zero mortality.
Conclusions:
- Early bronchoscopy in ICH with pulmonary infiltrates provides a high diagnostic yield and complements delayed procedures.
- Prompt bronchoscopic intervention, especially when empirical treatment is unsatisfactory, leads to earlier appropriate therapy, shorter hospital stays, and reduced costs.
- Recommend early bronchoscopy for ICH with pulmonary lesions to optimize patient management and outcomes.