Safety of bronchoalveolar lavage in young children with cystic fibrosis†
Corresponding Author
Claire E. Wainwright MBBS, MD, MRCP, FRACP
Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Australia
School of Medicine, University of Queensland, Brisbane, Australia
Department of Respiratory Medicine, Royal Children's Hospital, Herston Road, Herston, QLD, Australia 4029.Search for more papers by this authorKeith Grimwood MB ChB, MD, FRACP
School of Medicine, University of Queensland, Brisbane, Australia
Queensland Paediatric Infectious Diseases, Royal Children's Hospital, Brisbane, Australia
Search for more papers by this authorJohn B. Carlin BSc, PhD
Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
Department of Paediatrics, University of Melbourne, Melbourne, Australia
Search for more papers by this authorSuzanna Vidmar BSc
Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
Department of Paediatrics, University of Melbourne, Melbourne, Australia
Search for more papers by this authorPeter J. Cooper BSc, MB ChB, Grad Dip Health Law, MRCP, FRACP
Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia
Search for more papers by this authorPaul W. Francis MBBS, MD, FRACP
Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Australia
Search for more papers by this authorCatherine A. Byrnes MB ChB, FRACP
Department of Paediatrics, University of Auckland, New Zealand
Search for more papers by this authorBruce F. Whitehead MBBS, MRCP, FRACP
Paediatric Respiratory Unit, John Hunter Children's Hospital, Newcastle, Australia
Search for more papers by this authorA. James Martin MB ChB, MRCP, FRACP
Department of Pulmonary Medicine, Women and Children's Hospital, Adelaide, Australia
Search for more papers by this authorIan F. Robertson DCH, MBBS, MRCP, FRACP
Department of Respiratory and Sleep Medicine, Mater Children's Hospital, Brisbane, Australia
Search for more papers by this authorDavid M. Cooper MBBS, MSc, FRACP
Department of Respiratory and Sleep Medicine, Mater Children's Hospital, Brisbane, Australia
Search for more papers by this authorCarolyn J. Dakin MBBS, MPH, FRACP
Department of Respiratory and Sleep Medicine, Mater Children's Hospital, Brisbane, Australia
Search for more papers by this authorIan. B. Masters MBBS, FRACP, PhD
Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Australia
Search for more papers by this authorR. John Massie DCH, MBBS, PhD, FRACP
Department of Paediatrics, University of Melbourne, Melbourne, Australia
Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
Search for more papers by this authorPhilip J. Robinson B Med Sc, MBBS, FRACP, MD, PhD
Department of Paediatrics, University of Melbourne, Melbourne, Australia
Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
Search for more papers by this authorSarath Ranganathan MB ChB, MRCP, FRACP, PhD
Department of Paediatrics, University of Melbourne, Melbourne, Australia
Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
Search for more papers by this authorDavid S. Armstrong MB ChB, MD, FRACP
Department of Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, Australia
Search for more papers by this authorLyndall K. Patterson MBBS, FRANZCA
Department of Anaesthetics, Royal Children's Hospital, Brisbane, Australia
Search for more papers by this authorColin F. Robertson MBBS, MSc, MD, FRACP
Department of Paediatrics, University of Melbourne, Melbourne, Australia
Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
Search for more papers by this authorCorresponding Author
Claire E. Wainwright MBBS, MD, MRCP, FRACP
Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Australia
School of Medicine, University of Queensland, Brisbane, Australia
Department of Respiratory Medicine, Royal Children's Hospital, Herston Road, Herston, QLD, Australia 4029.Search for more papers by this authorKeith Grimwood MB ChB, MD, FRACP
School of Medicine, University of Queensland, Brisbane, Australia
Queensland Paediatric Infectious Diseases, Royal Children's Hospital, Brisbane, Australia
Search for more papers by this authorJohn B. Carlin BSc, PhD
Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
Department of Paediatrics, University of Melbourne, Melbourne, Australia
Search for more papers by this authorSuzanna Vidmar BSc
Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
Department of Paediatrics, University of Melbourne, Melbourne, Australia
Search for more papers by this authorPeter J. Cooper BSc, MB ChB, Grad Dip Health Law, MRCP, FRACP
Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia
Search for more papers by this authorPaul W. Francis MBBS, MD, FRACP
Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Australia
Search for more papers by this authorCatherine A. Byrnes MB ChB, FRACP
Department of Paediatrics, University of Auckland, New Zealand
Search for more papers by this authorBruce F. Whitehead MBBS, MRCP, FRACP
Paediatric Respiratory Unit, John Hunter Children's Hospital, Newcastle, Australia
Search for more papers by this authorA. James Martin MB ChB, MRCP, FRACP
Department of Pulmonary Medicine, Women and Children's Hospital, Adelaide, Australia
Search for more papers by this authorIan F. Robertson DCH, MBBS, MRCP, FRACP
Department of Respiratory and Sleep Medicine, Mater Children's Hospital, Brisbane, Australia
Search for more papers by this authorDavid M. Cooper MBBS, MSc, FRACP
Department of Respiratory and Sleep Medicine, Mater Children's Hospital, Brisbane, Australia
Search for more papers by this authorCarolyn J. Dakin MBBS, MPH, FRACP
Department of Respiratory and Sleep Medicine, Mater Children's Hospital, Brisbane, Australia
Search for more papers by this authorIan. B. Masters MBBS, FRACP, PhD
Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Australia
Search for more papers by this authorR. John Massie DCH, MBBS, PhD, FRACP
Department of Paediatrics, University of Melbourne, Melbourne, Australia
Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
Search for more papers by this authorPhilip J. Robinson B Med Sc, MBBS, FRACP, MD, PhD
Department of Paediatrics, University of Melbourne, Melbourne, Australia
Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
Search for more papers by this authorSarath Ranganathan MB ChB, MRCP, FRACP, PhD
Department of Paediatrics, University of Melbourne, Melbourne, Australia
Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
Search for more papers by this authorDavid S. Armstrong MB ChB, MD, FRACP
Department of Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, Australia
Search for more papers by this authorLyndall K. Patterson MBBS, FRANZCA
Department of Anaesthetics, Royal Children's Hospital, Brisbane, Australia
Search for more papers by this authorColin F. Robertson MBBS, MSc, MD, FRACP
Department of Paediatrics, University of Melbourne, Melbourne, Australia
Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
Search for more papers by this authorConflict of interest: None declared.
Abstract
Objective:
Our aim was to determine the safety of BAL in young children <6 years with CF.
Methods:
As part of a multi-center study of BAL-directed therapy, children with CF < 6 years had one or more BALs between September 1999 and December 2005. Adverse events were recorded intraoperatively and for 24 hr thereafter. Clinical characteristics before BAL, findings at bronchoscopy and BAL results were assessed as risk factors for adverse events.
Results:
333 BALs were conducted in 107 (56 males) children, median age 23.5 (range 1.6–67.5) months, including 170 (51%) for pulmonary exacerbation. 29 BALs (8.7%) were followed by fever ≥38.5°C and 10 (3%) had clinically significant episodes (five intraoperative hemoglobin desaturations to <90% requiring intervention, one tachyarrhythmia, two needing post-operative supplemental oxygen, one hospitalization for stridor). Two contaminated bronchoscopes were detected. 180 minor adverse events were recorded in 174 (52%) BAL procedures (137 altered cough, 41 fever <38.5°C). Low percentage BAL return (P = 0.002) and focal bronchitis (P = 0.02) were associated with clinically significant deterioration. Multivariable analysis identified Streptococcus pneumoniae (OR 22.3; 95% confidence interval (CI); 6.9,72), Pseudomonas aeruginosa (OR 2.4; 95% CI 1.0, 5.8), respiratory signs (OR 5.0; 95% CI 1.7, 14.6) and focal bronchitis (OR 5.9; 95% CI 1.2, 29.8) as independent risk factors for post-bronchoscopy fever ≥38.5°C.
Conclusions:
Adverse events are common with BAL in young CF children, but are usually transient and well tolerated. Parents should be counseled that signs of a pre-existing lower respiratory infection are associated with increased risk of post-BAL fever. Pediatr Pulmonol. 2008; 43:965–972. © 2008 Wiley-Liss, Inc.
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