Élie Azoulay1, Djamel Mokart2, Jérôme Lambert3, Virginie Lemiale4, Antoine Rabbat5, Achille Kouatchet6, François Vincent7, Didier Gruson8, Fabrice Bruneel9, Géraldine Epinette-Branche1, Ariane Lafabrie1, Rebecca Hamidfar-Roy10, Christophe Cracco11, Benoît Renard12, Jean-Marie Tonnelier13, François Blot14, Sylvie Chevret3 and Benoît Schlemmer1 Published ahead of print on June 25, 2010, doi:10.1164/rccm.201001-0018OC. American Journal of Respiratory and Critical Care Medicine Vol 182. pp. 1038-1046, (2010)
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.
Clinical trial registered with www.clinicaltrials.gov (NCT00248443).
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