Intensive Care Medicine

, Volume 32, Issue 6, pp 808–822 | Cite as

Diagnostic strategy in cancer patients with acute respiratory failure




Nearly 15% of cancer patients experience acute respiratory failure (ARF) requiring admission to the intensive care unit, where their mortality is about 50%. This review focuses on ARF in cancer patients. The most recent literature is reviewed, and emphasis is placed on current controversies, most notably the risk/benefit ratio of fiberoptic bronchoscopy and BAL in patients with severe hypoxemia.


Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) is the cornerstone of the causal diagnosis. However, the low diagnostic yield of about 50%, related to the widespread use of broad-spectrum antimicrobial therapy in cancer patients, has generated interest in high-resolution computed tomography (HRCT) and primary surgical lung biopsy. In patients with hypoxemia, bronchoscopy and BAL may trigger a need for invasive mechanical ventilation, thus considerably decreasing the chances of survival.


The place for recently developed, effective, noninvasive diagnostic tools (tests on sputum, blood, urine, and nasopharyngeal aspirates) needs to be determined. The prognosis is not markedly influenced by cancer characteristics; it is determined chiefly by the cause of ARF, need for mechanical ventilation, and presence of other organ failures. Although noninvasive ventilation reduces the need for endotracheal intubation and diminishes mortality rate, its prolonged use in patients with severe disease may preclude optimal diagnostic and therapeutic management. The appropriateness of switching to endotracheal mechanical ventilation in patients who fail noninvasive ventilation warrants evaluation.


This review discusses risks and benefits from invasive and non invasive diagnostic and therapeutic strategies in critically ill cancer patients with acute respiratory failure. Avenues for research are also suggested in order to improve survival in these very high risk patients.


Pneumonia Neutropenia Bone marrow transplantation Bronchoalveolar lavage Mechanical ventilation 

Supplementary material

134_2006_129_MOESM1_ESM.doc (678 kb)
Electronic Supplementary Material (DOC 684kb)/>)


  1. 1.
    Dunagan DP, Baker AM, Hurd DD, Haponik EF (1997) Bronchoscopic evaluation of pulmonary infiltrates following bone marrow transplantation. Chest 111:135–141PubMedGoogle Scholar
  2. 2.
    Murray PV, O'Brien ME, Padhani AR, Powles R, Cunningham D, Jeanes A, Ashley S (2001) Use of first line bronchoalveolar lavage in the immunosuppressed oncology patient. Bone Marrow Transplant 27:967–971CrossRefPubMedGoogle Scholar
  3. 3.
    White P, Bonacum JT, Miller CB (1997) Utility of fiberoptic bronchoscopy in bone marrow transplant patients. Bone Marrow Transplant 20:681–687CrossRefPubMedGoogle Scholar
  4. 4.
    Azoulay E, Thiery G, Chevret S, Moreau D, Darmon M, Bergeron A, Yang K, Meignin V, Ciroldi M, Le Gall JR, Tazi A, Schlemmer B (2004) The prognosis of acute respiratory failure in critically ill cancer patients. Medicine (Baltimore) 83:360–370Google Scholar
  5. 5.
    Chaoui D, Legrand O, Roche N, Cornet M, Lefebvre A, Peffault de Latour R, Sanhes L, Huchon G, Marie JP, Rabbat A (2004) Incidence and prognostic value of respiratory events in acute leukemia. Leukemia 18:670–675CrossRefPubMedGoogle Scholar
  6. 6.
    Reich G, Mapara MY, Reichardt P, Dorken B, Maschmeyer G (2001) Infectious complications after high-dose chemotherapy and autologous stem cell transplantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors. Bone Marrow Transplant 27:525–529CrossRefPubMedGoogle Scholar
  7. 7.
    Gruson D, Hilbert G, Bebear C, Allery A, Boiron JM, Pigneux A, Vargas F, Reiffers J, Gbikpi-Benissan G, Cardinaud JP (1998) Early infectious complications after bone marrow transplantation requiring medical ICU admission. Hematol Cell Ther 40:269–274PubMedGoogle Scholar
  8. 8.
    Jules-Elysee K, Stover DE, Yahalom J, White DA, Gulati SC (1992) Pulmonary complications in lymphoma patients treated with high-dose therapy autologous bone marrow transplantation. Am Rev Respir Dis 146:485–491PubMedGoogle Scholar
  9. 9.
    Cordonnier C, Bernaudin JF, Bierling P, Huet Y, Vernant JP (1986) Pulmonary complications occurring after allogeneic bone marrow transplantation. A study of 130 consecutive transplanted patients. Cancer 58:1047–1054PubMedGoogle Scholar
  10. 10.
    Brenner H (2002) Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis. Lancet 360:1131–1135CrossRefPubMedGoogle Scholar
  11. 11.
    Nachman JB, Sather HN, Sensel MG, Trigg ME, Cherlow JM, Lukens JN, Wolff L, Uckun FM, Gaynon PS (1998) Augmented post-induction therapy for children with high-risk acute lymphoblastic leukemia and a slow response to initial therapy. N Engl J Med 338:1663–1671CrossRefPubMedGoogle Scholar
  12. 12.
    Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, Morel P, Van Den Neste E, Salles G, Gaulard P, Reyes F, Lederlin P, Gisselbrecht C (2002) CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 346:235–242CrossRefPubMedGoogle Scholar
  13. 13.
    Barnes RA, Stallard N (2001) Severe infections after bone marrow transplantation. Curr Opin Crit Care 7:362–366CrossRefPubMedGoogle Scholar
  14. 14.
    Berrington JE, Flood TJ, Abinun M, Galloway A, Cant AJ (2000) Unsuspected Pneumocystis carinii pneumonia at presentation of severe primary immunodeficiency. Arch Dis Child 82:144–147CrossRefPubMedGoogle Scholar
  15. 15.
    Bodey GP (2000) Unusual presentations of infection in neutropenic patients. Int J Antimicrob Agents 16:93–95CrossRefPubMedGoogle Scholar
  16. 16.
    Dai MS, Ho CL, Chen YC, Kao WY, Chao TY (2000) Acute respiratory distress syndrome following intrathecal methotrexate administration: a case report and review of literature. Ann Hematol 79:696–699CrossRefPubMedGoogle Scholar
  17. 17.
    Cordonnier C, Bernaudin JF, Fleury J, Feuilhade M, Haioun C, Payen D, Huet Y, Atassi K, Vernant JP (1985) Diagnostic yield of bronchoalveolar lavage in pneumonitis occurring after allogeneic bone marrow transplantation. Am Rev Respir Dis 132:1118–1123PubMedGoogle Scholar
  18. 18.
    Gruson D, Hilbert G, Valentino R, Vargas F, Chene G, Bebear C, Allery A, Pigneux A, Gbikpi-Benissan G, Cardinaud JP (2000) Utility of fiberoptic bronchoscopy in neutropenic patients admitted to the intensive care unit with pulmonary infiltrates. Crit Care Med 28:2224–2230CrossRefPubMedGoogle Scholar
  19. 19.
    Milburn HJ, Prentice HG, du Bois RM (1987) Role of bronchoalveolar lavage in the evaluation of interstitial pneumonitis in recipients of bone marrow transplants. Thorax 42:766–772PubMedCrossRefGoogle Scholar
  20. 20.
    Springmeyer SC, Silvestri RC, Sale GE, Peterson DL, Weems CE, Huseby JS, Hudson LD, Thomas ED (1982) The role of transbronchial biopsy for the diagnosis of diffuse pneumonias in immunocompromised marrow transplant recipients. Am Rev Respir Dis 126:763–765PubMedGoogle Scholar
  21. 21.
    Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519–525CrossRefPubMedGoogle Scholar
  22. 22.
    Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487CrossRefPubMedGoogle Scholar
  23. 23.
    Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB (1999) Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 160:1957–1961PubMedGoogle Scholar
  24. 24.
    Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355CrossRefPubMedGoogle Scholar
  25. 25.
    Mayaud C, Cadranel J (2000) A persistent challenge: the diagnosis of respiratory disease in the non-AIDS immunocompromised host. Thorax 55:511–517CrossRefPubMedGoogle Scholar
  26. 26.
    Patel NR, Lee PS, Kim JH, Weinhouse GL, Koziel H (2005) The influence of diagnostic bronchoscopy on clinical outcomes comparing adult autologous and allogeneic bone marrow transplant patients. Chest 127:1388–1396CrossRefPubMedGoogle Scholar
  27. 27.
    Perkins GD, Chatterjee S, Giles S, McAuley DF, Quinton S, Thickett DR, Gao F (2005) Safety and tolerability of nonbronchoscopic lavage in ARDS. Chest 127:1358–1363CrossRefPubMedGoogle Scholar
  28. 28.
    Ewig S, Torres A, Riquelme R, El-Ebiary M, Rovira M, Carreras E, Rano A, Xaubet A (1998) Pulmonary complications in patients with haematological malignancies treated at a respiratory ICU. Eur Respir J 12:116–122CrossRefPubMedGoogle Scholar
  29. 29.
    Hilbert G, Gruson D, Vargas F, Valentino R, Chene G, Boiron JM, Pigneux A, Reiffers J, Gbikpi-Benissan G, Cardinaud JP (2000) Noninvasive continuous positive airway pressure in neutropenic patients with acute respiratory failure requiring intensive care unit admission. Crit Care Med 28:3185–3190CrossRefPubMedGoogle Scholar
  30. 30.
    Cazzato S, Zompatori M, Burzi M, Baruzzi G, Falcone F, Poletti V (1999) Bronchoalveolar lavage and transbronchial lung biopsy in alveolar and/or ground-glass opacification. Monaldi Arch Chest Dis 54:115–119PubMedGoogle Scholar
  31. 31.
    Afessa B, Tefferi A, Litzow MR, Krowka MJ, Wylam ME, Peters SG (2002) Diffuse alveolar hemorrhage in hematopoietic stem cell transplant recipients. Am J Respir Crit Care Med 166:641–645CrossRefPubMedGoogle Scholar
  32. 32.
    Shorr AF, Susla GM, O'Grady NP (2004) Pulmonary infiltrates in the non-HIV-infected immunocompromised patient: etiologies, diagnostic strategies, and outcomes. Chest 125:260–271CrossRefPubMedGoogle Scholar
  33. 33.
    Maitre B, Similowski T, Derenne JP (1995) Physical examination of the adult patient with respiratory diseases: inspection and palpation. Eur Respir J 8:1584–1593PubMedGoogle Scholar
  34. 34.
    Nenoff P, Kellermann S, Borte G, Horn LC, Ponisch W, Winkler J, Haustein UF (2000) Pulmonary nocardiosis with cutaneous involvement mimicking a metastasizing lung carcinoma in a patient with chronic myelogenous leukaemia. Eur J Dermatol 10:47–51PubMedGoogle Scholar
  35. 35.
    Raga J, Chrystal V, Coovadia HM (1984) Usefulness of clinical features and liver biopsy in diagnosis of disseminated herpes simplex infection. Arch Dis Child 59:820–824PubMedGoogle Scholar
  36. 36.
    Agusti C, Ramirez J, Picado C, Xaubet A, Carreras E, Ballester E, Torres A, Battochia C, Rodriguez-Roisin R (1995) Diffuse alveolar hemorrhage in allogeneic bone marrow transplantation. A postmortem study. Am J Respir Crit Care Med 151:1006–1010PubMedGoogle Scholar
  37. 37.
    Patterson TF, Kirkpatrick WR, White M, Hiemenz JW, Wingard JR, Dupont B, Rinaldi MG, Stevens DA, Graybill JR (2000) Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes. I3 Aspergillus Study Group. Medicine (Baltimore) 79:250–260CrossRefGoogle Scholar
  38. 38.
    Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert F, Denning DW, Donnelly JP, Edwards JE, Erjavec Z, Fiere D, Lortholary O, Maertens J, Meis JF, Patterson TF, Ritter J, Selleslag D, Shah PM, Stevens DA, Walsh TJ (2002) Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 34:7–14CrossRefPubMedGoogle Scholar
  39. 39.
    Gruson D, Hilbert G, Portel L, Boiron JM, Bebear CM, Vargas F, Bebear C, Reiffers J, Gbikpi-Benissan G, Cardinaud JP (1999) Severe respiratory failure requiring ICU admission in bone marrow transplant recipients. Eur Respir J 13:883–887CrossRefPubMedGoogle Scholar
  40. 40.
    Eiff M von, Zuhlsdorf M, Roos N, Thomas M, Buchner T, van de Loo J (1995) Pulmonary infiltrates in patients with haematologic malignancies: clinical usefulness of non-invasive bronchoscopic procedures. Eur J Haematol 54:157–162PubMedCrossRefGoogle Scholar
  41. 41.
    Azoulay E, Attalah H, Harf A, Schlemmer B, Delclaux C (2001) Granulocyte colony-stimulating factor or neutrophil-induced pulmonary toxicity: myth or reality? Systematic review of clinical case reports and experimental data. Chest 120:1695–1701CrossRefPubMedGoogle Scholar
  42. 42.
    Bredenfeld H, Franklin J, Nogova L, Josting A, Fries S, Mailander V, Oertel J, Diehl V, Engert A (2004) Severe pulmonary toxicity in patients with advanced-stage Hodgkin's disease treated with a modified bleomycin, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone, and gemcitabine (BEACOPP) regimen is probably related to the combination of gemcitabine and bleomycin: a report of the German Hodgkin's Lymphoma Study Group. J Clin Oncol 22:2424–2429CrossRefPubMedGoogle Scholar
  43. 43.
    White DA, Rankin JA, Stover DE, Gellene RA, Gupta S (1989) Methotrexate pneumonitis. Bronchoalveolar lavage findings suggest an immunologic disorder. Am Rev Respir Dis 139:18–21PubMedGoogle Scholar
  44. 44.
    Van Besien K, Devine S, Wickrema A, Jessop E, Amin K, Yassine M, Maynard V, Stock W, Peace D, Ravandi F, Chen YH, Hoffman R, Sossman J (2003) Regimen-related toxicity after fludarabine-melphalan conditioning: a prospective study of 31 patients with hematologic malignancies. Bone Marrow Transplant 32:471–476CrossRefPubMedGoogle Scholar
  45. 45.
    Rano A, Agusti C, Jimenez P, Angrill J, Benito N, Danes C, Gonzalez J, Rovira M, Pumarola T, Moreno A, Torres A (2001) Pulmonary infiltrates in non-HIV immunocompromised patients: a diagnostic approach using non-invasive and bronchoscopic procedures. Thorax 56:379–387CrossRefPubMedGoogle Scholar
  46. 46.
    Do KH, Lee JS, Seo JB, Song JW, Chung MJ, Heo JN, Song KS, Lim TH (2005) Pulmonary parenchymal involvement of low-grade lymphoproliferative disorders. J Comput Assist Tomogr 29:825–830CrossRefPubMedGoogle Scholar
  47. 47.
    Azoulay E, Fieux F, Moreau D, Thiery G, Rousselot P, Parrot A, Le Gall JR, Dombret H, Schlemmer B (2003) Acute monocytic leukemia presenting as acute respiratory failure. Am J Respir Crit Care Med 167:1329–1333CrossRefPubMedGoogle Scholar
  48. 48.
    Zahar JR, Robin M, Azoulay E, Fieux F, Nitenberg G, Schlemmer B (2002) Pneumocystis carinii pneumonia in critically ill patients with malignancy: a descriptive study. Clin Infect Dis 35:929–934CrossRefPubMedGoogle Scholar
  49. 49.
    Sharma S, Nadrous HF, Peters SG, Tefferi A, Litzow MR, Aubry MC, Afessa B (2005) Pulmonary complications in adult blood and marrow transplant recipients: autopsy findings. Chest 128:1385–1392CrossRefPubMedGoogle Scholar
  50. 50.
    Hohenthal U, Itala M, Salonen J, Sipila J, Rantakokko-Jalava K, Meurman O, Nikoskelainen J, Vainionpaa R, Kotilainen P (2005) Bronchoalveolar lavage in immunocompromised patients with haematological malignancy-value of new microbiological methods. Eur J Haematol 74:203–211CrossRefPubMedGoogle Scholar
  51. 51.
    Schvoerer E, Henriot S, Zachary P, Freitag R, Fuchs A, Fritsch S, Risch S, Meyer N, Caillard S, Lioure B, Stoll-Keller F (2005) Monitoring low cytomegalovirus viremia in transplanted patients by a real-time PCR on plasma. J Med Virol 76:76–81CrossRefPubMedGoogle Scholar
  52. 52.
    Maertens J, Van Eldere J, Verhaegen J, Verbeken E, Verschakelen J, Boogaerts M (2002) Use of circulating galactomannan screening for early diagnosis of invasive aspergillosis in allogeneic stem cell transplant recipients. J Infect Dis 186:1297–1306CrossRefPubMedGoogle Scholar
  53. 53.
    Anaissie EJ, Kontoyiannis DP, O'Brien S, Kantarjian H, Robertson L, Lerner S, Keating MJ (1998) Infections in patients with chronic lymphocytic leukemia treated with fludarabine. Ann Intern Med 129:559–566PubMedGoogle Scholar
  54. 54.
    Ramila E, Sureda A, Martino R, Santamaria A, Franquet T, Puzo C, Montesinos J, Perea G, Sierra J (2000) Bronchoscopy guided by high-resolution computed tomography for the diagnosis of pulmonary infections in patients with hematologic malignancies and normal plain chest X-ray. Haematologica 85:961–966PubMedGoogle Scholar
  55. 55.
    Heussel CP, Kauczor HU, Heussel GE, Fischer B, Begrich M, Mildenberger P, Thelen M (1999) Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography. J Clin Oncol 17:796–805PubMedGoogle Scholar
  56. 56.
    Heussel CP, Kauczor HU, Ullmann AJ (2004) Pneumonia in neutropenic patients. Eur Radiol 14:256–271CrossRefPubMedGoogle Scholar
  57. 57.
    Oude Nijhuis CS, Gietema JA, Vellenga E, Daenen SM, De Bont ES, Kamps WA, Groen HJ, van der Jagt EJ, van der Graaf WT (2003) Routine radiography does not have a role in the diagnostic evaluation of ambulatory adult febrile neutropenic cancer patients. Eur J Cancer 39:2495–2498CrossRefPubMedGoogle Scholar
  58. 58.
    Heussel CP, Kauczor HU, Heussel G, Fischer B, Mildenberger P, Thelen M (1997) Early detection of pneumonia in febrile neutropenic patients: use of thin-section CT. AJR Am J Roentgenol 169:1347–1353PubMedGoogle Scholar
  59. 59.
    Cordonnier C, Farcet JP, Desforges L, Brun-Buisson C, Vernant JP, Kuentz M, Dournon E (1984) Legionnaires' disease and hairy-cell leukemia. An unfortuitous association? Arch Intern Med 144:2373–2375CrossRefPubMedGoogle Scholar
  60. 60.
    Azoulay E, Darmon M, Delclaux C, Fieux F, Bornstain C, Moreau D, Attalah H, Le Gall JR, Schlemmer B (2002) Deterioration of previous acute lung injury during neutropenia recovery. Crit Care Med 30:781–786CrossRefPubMedGoogle Scholar
  61. 61.
    Azoulay E, Attalah H, Yang K, Herigault S, Jouault H, Brun-Buisson C, Brochard L, Harf A, Schlemmer B, Delclaux C (2003) Exacerbation with granulocyte colony-stimulating factor of prior acute lung injury during neutropenia recovery in rats. Crit Care Med 31:157–165CrossRefPubMedGoogle Scholar
  62. 62.
    Kovacs JA, Hiemenz JW, Macher AM, Stover D, Murray HW, Shelhamer J, Lane HC, Urmacher C, Honig C, Longo DL et al (1984) Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med 100:663–671PubMedGoogle Scholar
  63. 63.
    Denning DW, Evans EG, Kibbler CC, Richardson MD, Roberts MM, Rogers TR, Warnock DW, Warren RE (1997) Guidelines for the investigation of invasive fungal infections in haematological malignancy and solid organ transplantation. British Society for Medical Mycology. Eur J Clin Microbiol Infect Dis 16:424–436CrossRefPubMedGoogle Scholar
  64. 64.
    Maschmeyer G, Beinert T, Buchheidt D, Einsele H, Heussel CP, Kiehl M, Lorenz J (2003) Diagnosis and antimicrobial therapy of pulmonary infiltrates in febrile neutropenic patients-guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol 82:S118–S126PubMedGoogle Scholar
  65. 65.
    Stover DE, Zaman MB, Hajdu SI, Lange M, Gold J, Armstrong D (1984) Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med 101:1–7PubMedGoogle Scholar
  66. 66.
    Lipshultz SE, Rifai N, Dalton VM, Levy DE, Silverman LB, Lipsitz SR, Colan SD, Asselin BL, Barr RD, Clavell LA, Hurwitz CA, Moghrabi A, Samson Y, Schorin MA, Gelber RD, Sallan SE (2004) The effect of dexrazoxane on myocardial injury in doxorubicin-treated children with acute lymphoblastic leukemia. N Engl J Med 351:145–153CrossRefPubMedGoogle Scholar
  67. 67.
    Mueller C, Scholer A, Laule-Kilian K, Martina B, Schindler C, Buser P, Pfisterer M, Perruchoud AP (2004) Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med 350:647–654CrossRefPubMedGoogle Scholar
  68. 68.
    Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA (2002) Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 347:161–167CrossRefPubMedGoogle Scholar
  69. 69.
    Ip MS, Yuen KY, Woo PC, Luk WK, Tsang KW, Lam WK, Liang RH (1998) Risk factors for pulmonary tuberculosis in bone marrow transplant recipients. Am J Respir Crit Care Med 158:1173–1177PubMedGoogle Scholar
  70. 70.
    Meletis J, Arlet G, Dournon E, Pol S, Devergie A, Sportes C, Peraldi MN, Mayaud C, Perol Y, Gluckman E (1987) Legionnaires' disease after bone marrow transplantation. Bone Marrow Transplant 2:307–313PubMedGoogle Scholar
  71. 71.
    Panicek DM, Groskin SA, Chung CT, Heitzman ER, Sagerman RH (1987) Atypical distribution of Pneumocystis carinii infiltrates during radiation therapy. Radiology 163:689–690PubMedGoogle Scholar
  72. 72.
    Rossi SE, Erasmus JJ, McAdams HP, Sporn TA, Goodman PC (2000) Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics 20:1245–1259PubMedGoogle Scholar
  73. 73.
    Davies L, Mister R, Spence DP, Calverley PM, Earis JE, Pearson MG (1997) Cardiovascular consequences of fibreoptic bronchoscopy. Eur Respir J 10:695–698PubMedGoogle Scholar
  74. 74.
    Jones AM, O'Driscoll R (2001) Do all patients require supplemental oxygen during flexible bronchoscopy? Chest 119:1906–1909CrossRefPubMedGoogle Scholar
  75. 75.
    Bauer TT, Torres A, Ewig S, Hernandez C, Sanchez-Nieto JM, Xaubet A, Agusti C, Rodriguez-Roisin R (2001) Effects of bronchoalveolar lavage volume on arterial oxygenation in mechanically ventilated patients with pneumonia. Intensive Care Med 27:384–393CrossRefPubMedGoogle Scholar
  76. 76.
    Antonelli M, Conti G, Riccioni L, Meduri GU (1996) Noninvasive positive-pressure ventilation via face mask during bronchoscopy with BAL in high-risk hypoxemic patients. Chest 110:724–728PubMedGoogle Scholar
  77. 77.
    Maitre B, Jaber S, Maggiore SM, Bergot E, Richard JC, Bakthiari H, Housset B, Boussignac G, Brochard L (2000) Continuous positive airway pressure during fiberoptic bronchoscopy in hypoxemic patients. A randomized double-blind study using a new device. Am J Respir Crit Care Med 162:1063–1067PubMedGoogle Scholar
  78. 78.
    Springmeyer SC (1987) The clinical use of bronchoalveolar lavage. Chest 92:771–772PubMedGoogle Scholar
  79. 79.
    Campbell JH, Blessing N, Burnett AK, Stevenson RD (1993) Investigation and management of pulmonary infiltrates following bone marrow transplantation: an eight year review. Thorax 48:1248–1251PubMedGoogle Scholar
  80. 80.
    Weiss SM, Hert RC, Gianola FJ, Clark JG, Crawford SW (1993) Complications of fiberoptic bronchoscopy in thrombocytopenic patients. Chest 104:1025–1028PubMedGoogle Scholar
  81. 81.
    Hohenadel IA, Kiworr M, Genitsariotis R, Zeidler D, Lorenz J (2001) Role of bronchoalveolar lavage in immunocompromised patients with pneumonia treated with a broad spectrum antibiotic and antifungal regimen. Thorax 56:115–120CrossRefPubMedGoogle Scholar
  82. 82.
    Jain P, Sandur S, Meli Y, Arroliga AC, Stoller JK, Mehta AC (2004) Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates. Chest 125:712–722CrossRefPubMedGoogle Scholar
  83. 83.
    Maschmeyer G (2001) Pneumonia in febrile neutropenic patients: radiologic diagnosis. Curr Opin Oncol 13:229–235CrossRefPubMedGoogle Scholar
  84. 84.
    White DA, Wong PW, Downey R (2000) The utility of open lung biopsy in patients with hematologic malignancies. Am J Respir Crit Care Med 161:723–729PubMedGoogle Scholar
  85. 85.
    Peikert T, Rana S, Edell ES (2005) Safety, diagnostic yield, and therapeutic implications of flexible bronchoscopy in patients with febrile neutropenia and pulmonary infiltrates. Mayo Clin Proc 80:1414–1420PubMedGoogle Scholar
  86. 86.
    Mulabecirovic A, Gaulhofer P, Auner HW, Popper H, Krause R, Hesse C, Sill H (2004) Pulmonary infiltrates in patients with haematologic malignancies: transbronchial lung biopsy increases the diagnostic yield with respect to neoplastic infiltrates and toxic pneumonitis. Ann Hematol 83:420–422CrossRefPubMedGoogle Scholar
  87. 87.
    Wong PW, Stefanec T, Brown K, White DA (2002) Role of fine-needle aspirates of focal lung lesions in patients with hematologic malignancies. Chest 121:527–532CrossRefPubMedGoogle Scholar
  88. 88.
    Zihlif M, Khanchandani G, Ahmed HP, Soubani AO (2005) Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: improved outcome with specific diagnosis. Am J Hematol 78:94–99CrossRefPubMedGoogle Scholar
  89. 89.
    Yoo JH, Choi JH, Choi SM, Lee DG, Shin WS, Min WS, Kim CC (2005) Application of nucleic acid sequence-based amplification for diagnosis of and monitoring the clinical course of invasive aspergillosis in patients with hematologic diseases. Clin Infect Dis 40:392–398CrossRefPubMedGoogle Scholar
  90. 90.
    Ljungman P, de La Camara R, Milpied N, Volin L, Russell CA, Crisp A, Webster A (2002) Randomized study of valacyclovir as prophylaxis against cytomegalovirus reactivation in recipients of allogeneic bone marrow transplants. Blood 99:3050–3056CrossRefPubMedGoogle Scholar
  91. 91.
    Afessa B, Tefferi A, Litzow MR, Peters SG (2002) Outcome of diffuse alveolar hemorrhage in hematopoietic stem cell transplant recipients. Am J Respir Crit Care Med 166:1364–1368CrossRefPubMedGoogle Scholar
  92. 92.
    Abid SH, Malhotra V, Perry MC (2001) Radiation-induced and chemotherapy-induced pulmonary injury. Curr Opin Oncol 13:242–248CrossRefPubMedGoogle Scholar
  93. 93.
    Azoulay E, Attalah H, Yang K, Jouault H, Schlemmer B, Brun-Buisson C, Brochard L, Harf A, Delclaux C (2002) Exacerbation by granulocyte colony-stimulating factor of prior acute lung injury: implication of neutrophils. Crit Care Med 30:2115–2122CrossRefPubMedGoogle Scholar
  94. 94.
    Azoulay E, Herigault S, Levame M, Brochard L, Schlemmer B, Harf A, Delclaux C (2003) Effect of granulocyte colony-stimulating factor on bleomycin-induced acute lung injury and pulmonary fibrosis. Crit Care Med 31:1442–1448CrossRefPubMedGoogle Scholar
  95. 95.
    Karlin L, Darmon M, Thiery G, Ciroldi M, de Miranda S, Lefebvre A, Schlemmer B, Azoulay E (2005) Respiratory status deterioration during G-CSF-induced neutropenia recovery. Bone Marrow Transplant 6:6Google Scholar
  96. 96.
    Cadranel J, Wislez M, Antoine M (2002) Primary pulmonary lymphoma. Eur Respir J 20:750–762CrossRefPubMedGoogle Scholar
  97. 97.
    Porcu P, Cripe LD, Ng EW, Bhatia S, Danielson CM, Orazi A, McCarthy LJ (2000) Hyperleukocytic leukemias and leukostasis: a review of pathophysiology, clinical presentation and management. Leuk Lymphoma 39:1–18PubMedGoogle Scholar
  98. 98.
    Tanaka N, Matsumoto T, Miura G, Emoto T, Matsunaga N, Satoh Y, Oka Y (2002) CT findings of leukemic pulmonary infiltration with pathologic correlation. Eur Radiol 12:166–174CrossRefPubMedGoogle Scholar
  99. 99.
    Worthy S, Kang EY, Muller NL (1995) Acute lung disease in the immunocompromised host: differential diagnosis at high-resolution CT. Semin Ultrasound CT MR 16:353–360CrossRefPubMedGoogle Scholar
  100. 100.
    Cordonnier C, Fleury-Feith J, Escudier E, Atassi K, Bernaudin JF (1994) Secondary alveolar proteinosis is a reversible cause of respiratory failure in leukemic patients. Am J Respir Crit Care Med 149:788–794PubMedGoogle Scholar
  101. 101.
    Behrens GM, Stoll M, Schmidt RE (2001) Pulmonary hypersensitivity reaction induced by efavirenz. Lancet 357:1503–1504CrossRefPubMedGoogle Scholar
  102. 102.
    Bergeron A, Bergot E, Vilela G, Ades L, Devergie A, Esperou H, Socie G, Calvo F, Gluckman E, Ribaud P, Rousselot P, Tazi A (2002) Hypersensitivity pneumonitis related to imatinib mesylate. J Clin Oncol 20:4271–4272CrossRefPubMedGoogle Scholar
  103. 103.
    Saito K, Nakayamada S, Nakano K, Tokunaga M, Tsujimura S, Nakatsuka K, Adachi T, Tanaka Y (2004) Detection of Pneumocystis carinii by DNA amplification in patients with connective tissue diseases: re-evaluation of clinical features of P. carinii pneumonia in rheumatic diseases. Rheumatology (Oxf) 43:479–485CrossRefGoogle Scholar
  104. 104.
    Azoulay E, Recher C, Alberti C, Soufir L, Leleu G, Le Gall JR, Fermand JP, Schlemmer B (1999) Changing use of intensive care for hematological patients: the example of multiple myeloma. Intensive Care Med 25:1395–1401CrossRefPubMedGoogle Scholar
  105. 105.
    Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 31:104–112CrossRefPubMedGoogle Scholar
  106. 106.
    Blot F, Guiguet M, Nitenberg G, Leclercq B, Gachot B, Escudier B (1997) Prognostic factors for neutropenic patients in an intensive care unit: respective roles of underlying malignancies and acute organ failures. Eur J Cancer 33:1031–1037CrossRefPubMedGoogle Scholar
  107. 107.
    Groeger JS, White P Jr, Nierman DM, Glassman J, Shi W, Horak D, Price K (1999) Outcome for cancer patients requiring mechanical ventilation. J Clin Oncol 17:991–997PubMedGoogle Scholar
  108. 108.
    Larche J, Azoulay E, Fieux F, et a (2003) Improved prognosis in critically ill cancer patients with septic shock. Intensive Care Medicine 1688–1695)Google Scholar
  109. 109.
    Sculier JP, Paesmans M, Markiewicz E, Berghmans T (2000) Scoring systems in cancer patients admitted for an acute complication in a medical intensive care unit. Crit Care Med 28:2786–2792CrossRefPubMedGoogle Scholar
  110. 110.
    Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28:1322–1328CrossRefPubMedGoogle Scholar
  111. 111.
    Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine (1999) Guidelines for intensive care unit admission, discharge, and triage. Crit Care Med 27:633–638PubMedGoogle Scholar
  112. 112.
    Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B, Karlin L, Lefebvre A (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. Respiratory status deterioration during G-CSF-induced neutropenia recovery. J Clin Oncol 23:4406–4413CrossRefPubMedGoogle Scholar
  113. 113.
    Meert AP, Close L, Hardy M, Berghmans T, Markiewicz E, Sculier JP (2003) Noninvasive ventilation: application to the cancer patient admitted in the intensive care unit. Support Care Cancer 11:56–59PubMedGoogle Scholar
  114. 114.
    Darmon M, Azoulay E, Alberti C, Fieux F, Moreau D, Gall JR, Schlemmer B (2002) Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients. Intensive Care Med 28:1775–1780CrossRefPubMedGoogle Scholar
  115. 115.
    Afessa B, Tefferi A, Dunn WF, Litzow MR, Peters SG (2003) Intensive care unit support and Acute Physiology and Chronic Health Evaluation III performance in hematopoietic stem cell transplant recipients. Crit Care Med 31:1715–1721CrossRefPubMedGoogle Scholar
  116. 116.
    Khassawneh BY, White P Jr, Anaissie EJ, Barlogie B, Hiller FC (2002) Outcome from mechanical ventilation after autologous peripheral blood stem cell transplantation. Chest 121:185–188CrossRefPubMedGoogle Scholar
  117. 117.
    Boogaerts MA, Demuynck H (1994) The changing face of stem cell transplantation by the use of recombinant human granulocyte colony stimulating factor. Eur J Cancer 30A [Suppl 3]:S34–S39Google Scholar
  118. 118.
    Stein RS, Greer JP, Goodman S, Brandt SJ, Morgan DS, Macon WR, McCurley TL, Wolff SN (2000) Intensified preparative regimens and autologous transplantation in refractory or relapsed intermediate grade non-Hodgkin's lymphoma. Bone Marrow Transplant 25:257–262CrossRefPubMedGoogle Scholar
  119. 119.
    Azoulay E, Moreau D, Alberti C, Leleu G, Adrie C, Barboteu M, Cottu P, Levy V, Le Gall JR, Schlemmer B (2000) Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Med 26:1817–1823CrossRefPubMedGoogle Scholar
  120. 120.
    Massion PB, Dive AM, Doyen C, Bulpa P, Jamart J, Bosly A, Installe E (2002) Prognosis of hematologic malignancies does not predict intensive care unit mortality. Crit Care Med 30:2260–2270CrossRefPubMedGoogle Scholar
  121. 121.
    Groeger JS, Lemeshow S, Price K, Nierman DM, White P Jr, Klar J, Granovsky S, Horak D, Kish SK (1998) Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model. J Clin Oncol 16:761–770PubMedGoogle Scholar
  122. 122.
    Soares M, Fontes F, Dantas J, Gadelha D, Cariello P, Nardes F, Amorim C, Toscano L, Rocco JR (2004) Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study. Crit Care 8:R194–R203CrossRefPubMedGoogle Scholar
  123. 123.
    Schellongowski P, Benesch M, Lang T, Traunmuller F, Zauner C, Laczika K, Locker GJ, Frass M, Staudinger T (2004) Comparison of three severity scores for critically ill cancer patients. Intensive Care Med 30:430–436CrossRefPubMedGoogle Scholar
  124. 124.
    Guiguet M, Blot F, Escudier B, Antoun S, Leclercq B, Nitenberg G (1998) Severity-of-illness scores for neutropenic cancer patients in an intensive care unit: Which is the best predictor? Do multiple assessment times improve the predictive value? Crit Care Med 26:488–493CrossRefPubMedGoogle Scholar
  125. 125.
    Leleu G, Azoulay E, Chen Y, Ribaud P, Barboteu M, Adrie C, Socié G, Gluckman E, Le Gall J (1998) Prognostic factors of allogenic bone marrow recipients admitted to ICU. Am J Respir Crit Care Med 157:A299Google Scholar
  126. 126.
    Rubenfeld GD, Crawford SW (1996) Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: a case for evidence-based guidelines. Ann Intern Med 125:625–633PubMedGoogle Scholar
  127. 127.
    Huaringa AJ, Leyva FJ, Giralt SA, Blanco J, Signes-Costa J, Velarde H, Champlin RE (2000) Outcome of bone marrow transplantation patients requiring mechanical ventilation. Crit Care Med 28:1014–1017CrossRefPubMedGoogle Scholar
  128. 128.
    Shorr AF, Moores LK, Edenfield WJ, Christie RJ, Fitzpatrick TM (1999) Mechanical ventilation in hematopoietic stem cell transplantation: can we effectively predict outcomes? Chest 116:1012–1018CrossRefPubMedGoogle Scholar
  129. 129.
    Soubani AO, Kseibi E, Bander JJ, Klein JL, Khanchandani G, Ahmed HP, Guzman JA (2004) Outcome and prognostic factors of hematopoietic stem cell transplantation recipients admitted to a medical ICU. Chest 126:1604–1611CrossRefPubMedGoogle Scholar
  130. 130.
    Caillot D, Mannone L, Cuisenier B, Couaillier JF (2001) Role of early diagnosis and aggressive surgery in the management of invasive pulmonary aspergillosis in neutropenic patients. Clin Microbiol Infect 7 [Suppl 2]:54–61Google Scholar
  131. 131.
    Wenzel R, Del Favero A, Kibbler C, Rogers T, Rotstein C, Mauskopf J, Morris S, Schlamm H, Troke P, Marciniak A (2005) Economic evaluation of voriconazole compared with conventional amphotericin B for the primary treatment of aspergillosis in immunocompromised patients. J Antimicrob Chemother 55:352–361CrossRefPubMedGoogle Scholar
  132. 132.
    Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, Kern WV, Marr KA, Ribaud P, Lortholary O, Sylvester R, Rubin RH, Wingard JR, Stark P, Durand C, Caillot D, Thiel E, Chandrasekar PH, Hodges MR, Schlamm HT, Troke PF, de Pauw B (2002) Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347:408–415CrossRefPubMedGoogle Scholar
  133. 133.
    Jennings LC, Anderson TP, Werno AM, Beynon KA, Murdoch DR (2004) Viral etiology of acute respiratory tract infections in children presenting to hospital: role of polymerase chain reaction and demonstration of multiple infections. Pediatr Infect Dis J 23:1003–1007PubMedGoogle Scholar
  134. 134.
    Murdoch DR (2005) Impact of rapid microbiological testing on the management of lower respiratory tract infection. Clin Infect Dis 41:1445–1447CrossRefPubMedGoogle Scholar
  135. 135.
    Templeton KE, Scheltinga SA, van den Eeden WC, Graffelman AW, van den Broek PJ, Claas EC (2005) Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin Infect Dis 41:345–351CrossRefPubMedGoogle Scholar
  136. 136.
    Combes A, Mokhtari M, Couvelard A, Trouillet JL, Baudot J, Henin D, Gibert C, Chastre J (2004) Clinical and autopsy diagnoses in the intensive care unit: a prospective study. Arch Intern Med 164:389–392CrossRefPubMedGoogle Scholar
  137. 137.
    Al-Saidi F, Diaz-Granados N, Messner H, Herridge MS (2002) Relationship between premortem and postmortem diagnosis in critically ill bone marrow transplantation patients. Crit Care Med 30:570–573CrossRefPubMedGoogle Scholar
  138. 138.
    Kroschinsky F, Weise M, Illmer T, Haenel M, Bornhaeuser M, Hoeffken G, Ehninger G, Schuler U (2002) Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies. Intensive Care Med 28:1294–1300CrossRefPubMedGoogle Scholar
  139. 139.
    Vallot F, Paesmans M, Berghmans T, Sculier JP (2003) Leucopenia is an independent predictor in cancer patients requiring invasive mechanical ventilation: a prognostic factor analysis in a series of 168 patients. Support Care Cancer 11:236–241PubMedGoogle Scholar
  140. 140.
    Depuydt PO, Benoit DD, Vandewoude KH, Decruyenaere JM, Colardyn FA (2004) Outcome in noninvasively and invasively ventilated hematologic patients with acute respiratory failure. Chest 126:1299–1306CrossRefPubMedGoogle Scholar
  141. 141.
    Soares M, Salluh JI, Spector N, Rocco JR (2005) Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for > 24 hrs. Crit Care Med 33:520–526CrossRefPubMedGoogle Scholar
  142. 142.
    Martin WJ, 2nd, Smith TF, Sanderson DR, Brutinel WM, Cockerill FR, 3rd, Douglas WW (1987) Role of bronchoalveolar lavage in the assessment of opportunistic pulmonary infections: utility and complications. Mayo Clin Proc 62:549–557 Google Scholar
  143. 143.
    Xaubet A, Torres A, Marco F, Puig-De la Bellacasa J, Faus R, Agusti-Vidal A (1989) Pulmonary infiltrates in immunocompromised patients. Diagnostic value of telescoping plugged catheter and bronchoalveolar lavage. Chest 95:130–135Google Scholar
  144. 144.
    Campbell JH, Raina V, Banham SW, Cunningham D, Soukop M (1989) Pulmonary infiltrates–diagnostic problems in lymphoma. Postgrad Med J 65:881–884Google Scholar
  145. 145.
    Pisani RJ, Wright AJ (1992) Clinical utility of bronchoalveolar lavage in immunocompromised hosts. Mayo Clin Proc 67:221–227Google Scholar
  146. 146.
    Maschmeyer G, Link H, Hiddemann W, Meyer P, Helmerking M, Eisenmann E, Schmitt J, Adam D (1994) Pulmonary infiltrations in febrile patients with neutropenia. Risk factors and outcome under empirical antimicrobial therapy in a randomized multicenter study. Cancer 73:2296–2304Google Scholar
  147. 147.
    Cazzadori A, Di Perri G, Todeschini G, Luzzati R, Boschiero L, Perona G, Concia E (1995) Transbronchial biopsy in the diagnosis of pulmonary infiltrates in immunocompromised patients. Chest 107:101–106Google Scholar
  148. 148.
    Pagano L, Pagliari G, Basso A, Marra R, Sica S, Frigieri L, Morace G, Ardito F, Leone G (1997) The role of bronchoalveolar lavage in the microbiological diagnosis of pneumonia in patients with haematological malignancies. Ann Med 29:535–540Google Scholar
  149. 149.
    Heurlin N, Lonnqvist B, Tollemar J, Ehrnst A (1989) Fiberoptic bronchoscopy for diagnosis of opportunistic pulmonary infections after bone marrow transplantation. Scand J Infect Dis 21:359–366Google Scholar
  150. 150.
    Abu-Farsakh HA, Katz RL, Atkinson N, Champlin RE (1995) Prognostic factors in bronchoalveolar lavage in 77 patients with bone marrow transplants. Acta Cytol 39:1081–1088Google Scholar
  151. 151.
    Glazer M, Breuer R, Berkman N, Lossos IS, Kapelushnik J, Nagler A, Naparstek E, Kramer MR, Lafair J, Engelhard D, Or R (1998) Use of fiberoptic bronchoscopy in bone marrow transplant recipients. Acta Haematol 99:22–26Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Service de Réanimation MédicaleHôpital Saint-Louis et Université Paris 7ParisFrance

Personalised recommendations