Utilidad del lavado broncoalveolar en niños inmunodeprimidos: rendimiento y complicaciones

Vega-Briceño, L.E.; Holmgren, N.L.; Bertrand, P.; Rodríguez, J.I.; Barriga, F.; Contreras, I.; Sánchez, I.

doi:10.1016/S0300-2896(04)75594-5

Archivos de Bronconeumología

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Vol. 40. Issue 12.

Pages 570-574 (December 2004)

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Pages 570-574 (December 2004)

DOI: 10.1016/S0300-2896(04)75594-5

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Utilidad del lavado broncoalveolar en niños inmunodeprimidos: rendimiento y complicaciones

Utility of Bronchoalveolar Lavage in Immunocompromised Children: Diagnostic Yield and Complications

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L.E. Vega-Briceñoa,

Corresponding author

LEvega@puc.cl

Correspondencia: Sección de Respiratorio Pediátrico. Departamento de Pediatría.Pontificia Universidad Católica de Chile. Lira, 85, 5.° piso, Laboratorio de respiratorio. Santiago de Chile. Chile

, N.L. Holmgrena, P. Bertranda, J.I. Rodríguezb, F. Barrigac, I. Contrerasa, I. Sáncheza

a Sección de Respiratorio Pediátrico. Departamento de Pediatría. Pontificia Universidad Católica de Chile. Santiago de Chile

b Unidad de Cuidados Intensivos Pediátricos. Departamento de Pediatría. Pontificia Universidad Católica de Chile. Santiago de Chile

c Sección de Oncología Pediátrica. Departamento de Pediatría. Pontificia Universidad Católica de Chile. Santiago de Chile. Chile

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Objetivo

Los niños inmunodeprimidos presentan el riesgo de desarrollar neumonía por gérmenes oportunistas. El papel del lavado broncoalveolar (LBA) en la evaluación de estos pacientes es aún controvertido.

Material Y Método

Se revisaron las fichas de pacientes con inmunodepresión y síntomas respiratorios a los que se les había practicado un LBA en el Servicio de Pediatría del Hospital Clínico de la Pontificia Universidad Católica de Chile.

Resultados

Se practicaron 68 LBA en 54 niños inmunodeprimidos (edad media: 7,5 años). Los síntomas respiratorios más frecuentes fueron fiebre (90%) y tos y dificultad respiratoria (81%); el 18% tenía neutropenia y el 43%, trombocitopenia. Todos los pacientes estaban en tratamiento antibiótico de amplio espectro. Las muestras del LBA proporcionaron un germen específico en 25 pacientes (37%). Los patógenos aislados fueron: bacterias en 21 casos, virus en 6, Pneumocystis carinii en 5, hongos en 4 y Mycobacterium tuberculosis en uno. Catorce (19%) LBA se realizaron a niños que recibían ventilación mecánica. La evolución fue satisfactoria en todos los casos. Se registraron 21 complicaciones, 17 menores (hipoxemia leve o fiebre) y 4 mayores que requirieron intubación traqueal. No se registraron muertes.

Conclusiones

La evaluación fibrobroncoscópica asociada a un LBA fue un método seguro, con un adecuado rendimiento, que permitió evaluar la etiología de los infiltrados pulmonares en la radiografía de tórax. Tanto los resultados positivos como los negativos del LBA contribuyeron al tratamiento de estos pacientes.

Palabras clave:

Lavado broncoalveolar

Fibrobroncoscopia

Niños

Inmunodeficiencia

Objective

Immunocompromised children are at high risk for developing pneumonia due to opportunistic pathogens. The role of bronchoalveolar lavage (BAL) in the evaluation of such patients is still controversial.

Material And Method

We reviewed the hospital records of immunosuppressed patients with respiratory symptoms who had undergone BAL in the pediatric department of the Hospital Clínico de la Pontificia Universidad Católica of Chile.

Results

Sixty-eight BAL were performed on 54 children (mean age: 7.5 years) receiving wide-spectrum antibiotic treatment. The most frequent respiratory signs and symptoms were fever (90%) and cough and respiratory distress (81%); 18% had neutropenia and 43% thrombocytopenia. A specific pathogen was identified in BAL samples for 25 patients (37%). The pathogens isolated were bacteria in 21 cases, viruses in 6, Pneumocystis carinii in 5, fungi in 4, and Mycobacterium tuberculosis in one. Fourteen (19%) of the children who underwent BAL were on mechanical ventilation. Outcome was satisfactory in all cases. Twenty-one complications were recorded, 17 of which were minor (mild hypoxemia or fever) and 4 major, requiring tracheal intubation. No deaths were recorded.

Conclusions

Evaluation by fiberoptic bronchoscopy together with BAL proved to be a safe procedure with an adequate diagnostic yield that made it possible to determine the etiology of the pulmonary infiltrates seen in chest x-rays. Both positive and negative results of BAL were useful for treating the patients.

Keywords:

Bronchoalveolar lavage

Fiberoptic bronchoscopy

Children

Immunodeficiency

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Bibliografía

[1.]

D.M. Williams, J.S. Remington.

Pulmonary infection in the immunocompromised host.

Am Rev Resp Dis, 114 (1976), pp. 259-264

[2.]

J.R. Park, S. Fogarty, T.V. Brogan.

Clinical utility of bronchoalveolar lavage in pediatric cancer patients.

Med Pediatr Oncol, 39 (2002), pp. 175-180

http://dx.doi.org/10.1002/mpo.10130 | Medline

[3.]

D. Stefanutti, L. Morais, J.C. Fournet, D. Jan, J.L. Casanova, P. Scheinmann, et al.

Value of open lung biopsy in immunocompromised children.

J Pediatr, 137 (2000), pp. 165-171

http://dx.doi.org/10.1067/mpd.2000.106228 | Medline

[4.]

E.N. Pattishall, E.N. Blakeslee, D.M. Orenstein.

Use of bronchoalveolar lavage in immunocompromised children with pneumonia.

Pediatr Pulmonol, 5 (1988), pp. 1-5

Medline

[5.]

J. Ben-Ari, I. Yaniv, E. Nahum, J. Stein, Z. Samra, T. Schonfeld.

Yield of bronchoalveolar lavage in ventilated and non-ventilated children after bone marrow transplantation.

Bone Marrow Transplant, 27 (2001), pp. 191-194

http://dx.doi.org/10.1038/sj.bmt.1702773 | Medline

[6.]

N.J. Gross.

Pulmonary effects of radiation therapy.

Ann Intern Med, 86 (1977), pp. 81-92

Medline

[7.]

A. Kornecki, S.D. Shemie.

Open lung biopsy in children with respiratory failure.

Crit Care Med, 29 (2001), pp. 1247-1250

Medline

[8.]

D. Potter, H.I. Pass, S. Brower.

Prospective randomized study of open lung biopsy versus empirical antibiotic therapy for acute pneumonitis in non-neutropenic cancer patients.

Ann Thorac Surg, 40 (1985), pp. 422-428

Medline

[9.]

L. Davies, S. Dolgin, M. Kattan.

Morbidity and mortality of lung biopsy in children.

Pediatrics, 99 (1997), pp. 660-664

Medline

[10.]

F. Midulla, J. De Blic, A. Barbato, A. Bush, E. Eber, S. Kotecha, et al.

Flexible endoscopy of paediatric airway.

Eur Resp J, 22 (2003), pp. 698-708

[11.]

J. De Blic, F. Midulla, A. Barbato, A. Clement, I. Dab, E. Eber, et al.

Bronchoalveolar lavage in children.

Eur Resp J, 15 (2000), pp. 217-231

[12.]

N.T. Feldman, J.E. Pennington, M.G. Ehrie.

Transbronchial lung biopsy in the compromised host.

Jama, 238 (1997), pp. 1377-1379

Medline

[13.]

P.A. Pizzo.

Management of fever in patients with cancer and treatment induced neutropenia.

N Engl J Med, 328 (1993), pp. 1323-1332

http://dx.doi.org/10.1056/NEJM199305063281808 | Medline

[14.]

F. Ratjen, U. Costabel, W. Havers.

Differential cytology of bronchoalveolar lavage fluid in immunosuppressed children with pulmonary infiltrates.

Arch Dis Child, 74 (1994), pp. 507-511

Medline

[15.]

R. Ronco, A. Castillo, J.A. Carrasco, C. Carrasco, R. Parraguez, M. Zamora, et al.

Sedación y analgesia para procedimientos pediátricos fuera del pabellón.

Rev Chil Pediatr, 74 (2003), pp. 171-178

[16.]

E. Nussbaum.

Pediatric fiberoptic bronchoscopy: clinical experience with 2836 bronchoscopies.

Pediatr Crit Care Med, 3 (2002), pp. 171-176

Medline

[17.]

A. Barbato, M. Magarotto, M. Crivello, A. Novello, A. Cracco, J. De Blic, et al.

Use of the paediatric bronchoscope, flexible and rigid, in 51 European centres.

Eur Resp J, 10 (1997), pp. 1761-1766

[18.]

N.L. Holmgren, M. Córdova, P. Ortúzar, I. Sánchez.

Broncoscopia flexible en la reexpansión de atelectasias persistentes en pediatría.

Arch Bronconeumol, 38 (2001), pp. 367-371

Medline

[19.]

J. Riedler, J. Grigg, C.F. Robertson.

Role of bronchoalveolar lavage in children with lung disease.

Eur Resp J, 8 (1995), pp. 1725-1730

[20.]

C.H. Marquette, M.C. Copin, F. Wallet.

Diagnostic test for pneumonia in ventilated patients: prospective evaluation of diagnostic accuracy using histology as a diagnostic gold standard.

Am J Respir Crit Care Med, 151 (1995), pp. 1878-1888

http://dx.doi.org/10.1164/ajrccm.151.6.7767535 | Medline

[21.]

L. Papazian, P. Thomas, L. Garbe.

Bronchoscopic and blind sampling techniques for the diagnosis of ventilator-associated pneumonia.

Am J Respir Crit Care Med, 152 (1995), pp. 1982-1991

http://dx.doi.org/10.1164/ajrccm.152.6.8520766 | Medline

[22.]

J. Chastre, J.Y. Fagon, M. Bornet-Lecso.

Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia.

Am J Respir Crit Care Med, 152 (1995), pp. 231-240

http://dx.doi.org/10.1164/ajrccm.152.1.7599829 | Medline

[23.]

F. Prado, L. Boza, J. Badilla, D. Isamitt.

Fibrobroncoscopia en pediatría: utilidad diagnóstica y terapéutica.

Rev Chil Pediatr, 69 (1998), pp. 207-214

[24.]

A. Zamorano, A. Núñez, M.E. Salinas, H. Navarro, L. Holmgren, P. Bertrand, et al.

Experiencia clínica de la utilidad del lavado broncoalveolar en pediatría.

Rev Chil Pediatr, 73 (2002), pp. 576-582

[25.]

P. White, J.T. Bonacum, C.B. Miller.

Utility of fiberoptic bronchoscopy in bone marrow transplant patients.

Bone Marrow Transpl, 20 (1997), pp. 681-687

[26.]

F.W. Khan, J.M. Jones.

Diagnosing bacterial respiratory infection by bronchoalveolar lavage.

J Infect Dis, 155 (1987), pp. 862-869

Medline

[27.]

J. De Blic, V. Marchac, P. Scheinmann.

Complications of flexible bronchoscopy in children: prospective study of 1328 procedures.

Eur Resp J, 20 (2002), pp. 1271-1276

[28.]

M. Bruce, D.O. Schnapf.

Oxygen desaturation during fiberoptic bronchoscopy in pediatric patients.

Chest, 91 (1991), pp. 467-471

Medline

[29.]

C. Rodríguez, M.P. Sossa.

Factores asociados a complicaciones debidas a la realización de broncoscopia en pacientes pediátricos.

Arch Bronconeumol, 39 (2003), pp. 501-506

Medline

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