Diagnostic Strategy for Hematology and Oncology Patients with Acute Respiratory Failure Randomized Controlled Trial
Diagnostic Strategy for Hematology and Oncology Patients with Acute Respiratory Failure Randomized Controlled Trial
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DOI：
10.1164/rccm.201001-0018oc
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发表时间：
2010-10-15
影响因子：
24.7
通讯作者：
Schlemmer, Benoit
中科院分区：
文献类型：
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作者：
Azoulay, Elie;Mokart, Djamel;Schlemmer, Benoit
基本原理：呼吸系统事件在血液学和肿瘤学患者中很常见，多达一半的病例表现为低氧性急性呼吸衰竭（ARF）。确定ARF的原因至关重要。纤维支气管镜检查和支气管肺泡灌洗（FO-BAL）是一种侵入性检查，可能导致呼吸恶化。最近的非侵入性诊断测试可能修改了FO-BAL.Objectives的风险/效益比：以确定是否FO-BAL在癌症患者ARF增加插管的需要，以及是否无创性检测单独不低于无创性检测加FO-BAL.Methods：我们进行了一项多中心随机对照试验，样本量计算两个终点。在重症监护室入院时未接受辅助支持的癌症和不明原因ARF患者随机接受早期FO-BAL+无创检测（n = 113）或仅接受无创检测（n = 106）。主要终点是需要插管和机械通气的患者数量。主要的次要终点是没有确定原因的ARF.Measurements和主要结果的患者数量：需要机械通气是没有显着更大的FO-BAL组比非侵入性组（35.4vs.38.7%; P = 0.62）。无创组中未诊断的患者比例并不更低（21.7% vs. 20.4%;差异，-1.3% [-10.4至7.7]）。结论：在重症监护室进行的FO-BAL并未显著增加ARF危重癌症患者的插管要求。对于确定ARF的原因，单独的无创检测并不劣于无创检测加FO-BAL。
Rationale: Respiratory events are common in hematology and oncology patients and manifest as hypoxemic acute respiratory failure (ARF) in up to half the cases. Identifying the cause of ARF is crucial. Fiberoptic bronchoscopy with bronchoalveolar lavage (FO-BAL) is an invasive test that may cause respiratory deterioration. Recent noninvasive diagnostic tests may have modified the risk/benefit ratio of FO-BAL.Objectives: To determine whether FO-BAL in cancer patients with ARF increased the need for intubation and whether noninvasive testing alone was not inferior to noninvasive testing plus FO-BAL.Methods: We performed a multicenter randomized controlled trial with sample size calculations for both end points. Patients with cancer and ARF of unknown cause who were not receiving ventilatory support at intensive care unit admission were randomized to early FO-BAL plus noninvasive tests (n = 113) or noninvasive tests only (n = 106). The primary end point was the number of patients needing intubation and mechanical ventilation. The major secondary end point was the number of patients with no identified cause of ARF.Measurements and Main Results: The need for mechanical ventilation was not significantly greater in the FO-BAL group than in the noninvasive group (35.4 vs. 38.7%; P = 0.62). The proportion of patients with no diagnosis was not smaller in the noninvasive group (21.7 vs. 20.4%; difference, -1.3% [-10.4 to 7.7]).Conclusions: FO-BAL performed in the intensive care unit did not significantly increase intubation requirements in critically ill cancer patients with ARF. Noninvasive testing alone was not inferior to noninvasive testing plus FO-BAL for identifying the cause of ARF.