Performance of a standardized bronchoalveolar lavage protocol in a comprehensive cancer center: a prospective 2-year study.
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TLDR
Flexible bronchoscopy with bronchoalveolar lavage is performed widely for the diagnosis of pulmonary infections in patients with cancer, but there is no consensus regarding the technical parameters of the lavage procedure in this setting.Abstract:
BACKGROUND:
Flexible bronchoscopy with bronchoalveolar lavage (BAL) is performed widely for the diagnosis of pulmonary infections in patients with cancer, but there is no consensus regarding the technical parameters of the lavage procedure in this setting.
METHODS:
The authors evaluated the mechanics (instilled and recovered volumes), diagnostic yield, and safety of a standardized BAL protocol in 284 patients with cancer who underwent bronchoscopy for the evaluation of new radiologic infiltrates.
RESULTS:
Physician adherence to the BAL protocol was > 90%. The most common protocol deviations were reductions in the saline volume instilled because of actual or anticipated oxyhemoglobin desaturation during the procedure. The mean volume instilled was 121.5 ± 13.9 mL, the mean volume recovered was 68.7 ± 18.1 mL, and the mean ratio of volume instilled to that recovered was 56.7% ± 14.5%. The overall diagnostic yield of BAL was 33.8% and was higher in the nonhematologic malignancy group (42.3% vs 29.4%; P = .021). The diagnostic yield in neutropenic patients was significantly higher than in non-neutropenic patients (41.5% vs 24.6%; P = .019). No major complications were encountered.
CONCLUSIONS:
In summary, the diagnostic performance of a standardized BAL protocol was comparable to that of nonprotocolized BAL reported in the literature with few complications. Adherence to a standardized BAL protocol may improve clinical and laboratory comparisons between studies, potentially facilitating research into the diagnosis and management of pneumonia in patients with cancer. Cancer 2011. © 2011 American Cancer Society.read more
Citations
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References
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Defining Opportunistic Invasive Fungal Infections in Immunocompromised Patients with Cancer and Hematopoietic Stem Cell Transplants: An International Consensus
Sibel Ascioglu,John H. Rex,B.E. de Pauw,John E. Bennett,J. Bille,F. Crokaert,David W. Denning,J.P. Donnelly,J. E. Edwards,Z. Erjavec,D. Fiere,O. Lortholary,Johan Maertens,Jacques F. Meis,Thomas F. Patterson,J. Ritter,D. Selleslag,Palak Shah,David A. Stevens,Thomas J. Walsh +19 more
TL;DR: A set of research-oriented definitions for the IFIs most often seen and studied in immunocompromised patients with cancer is proposed and three levels of probability are proposed: "proven," "probable," and "possible."
Journal Article
Technical recommendations and guidelines for bronchoalveolar lavage (BAL)
TL;DR: This group report was developed jointly by: U. Costabel (Essen), C. Dane!
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Outcomes of Bacteremia in Patients with Cancer and Neutropenia: Observations from Two Decades of Epidemiological and Clinical Trials
TL;DR: The prognostic significance of major organ and tissue infection was examined in 909 episodes of bacteremia and recovery of the granulocyte count predicted a superior response and should be considered in decisions concerning modification of therapy and use of colony-stimulating factors.
Journal ArticleDOI
Comparison of Epidemiological, Clinical, and Biological Features of Invasive Aspergillosis in Neutropenic and Nonneutropenic Patients: A 6-Year Survey
A. Cornillet,Christophe Camus,Stanislas Nimubona,Virginie Gandemer,Pierre Tattevin,Chantal Belleguic,Sylviane Chevrier,C. Meunier,C. Lebert,M. Aupee,Sylvie Caulet-Maugendre,M. Faucheux,Bernard Lelong,Emmanuelle Leray,Claude Guiguen,Jean-Pierre Gangneux +15 more
TL;DR: This survey at a whole institution underlines the high number of cases of invasive aspergillosis among nonneutropenic patients, with an overall mortality rate that was significantly higher than that for neutropenia patients.
Journal ArticleDOI
Clinical role of bronchoalveolar lavage in adults with pulmonary disease.
Goldstein Ra,Rohatgi Pk,Bergofsky Eh,Block Er,Daniele Rp,Dantzker Dr,Davis Gs,Gary W. Hunninghake,Talmadge E. King,Metzger Wj +9 more
TL;DR: BAL has been found to be diagnostic in several infectious and noninfectious diseases involving the lower respiratory tract, and it provides valuable information that may be helpful in characterizing the prognosis and response to therapy in certain interstitial diseases of the lung.
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