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

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00064165%3A_____%2F19%3A10400642" target="_blank" >RIV/00064165:_____/19:10400642 - isvavai.cz</a>

Alternative codes found

RIV/00216208:11110/19:10400642 RIV/00216208:11140/19:10400642 RIV/00669806:_____/19:10400642

Result on the web

<a href="https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=mjq5QMcS4T" target="_blank" >https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=mjq5QMcS4T</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1183/13993003.02442-2018" target="_blank" >10.1183/13993003.02442-2018</a>

Result language

angličtina

Original language name

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

Original language description

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&lt; 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.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30223 - Anaesthesiology

Project

—

Continuities

V - Vyzkumna aktivita podporovana z jinych verejnych zdroju

Publication year

2019

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

European Respiratory Journal

ISSN

0903-1936

e-ISSN

—

Volume of the periodical

54

Issue of the periodical within the volume

1

Country of publishing house

CH - SWITZERLAND

Number of pages

11

Pages from-to

1802442

UT code for WoS article

000486537500014

EID of the result in the Scopus database

2-s2.0-85070658740