Utilidad del lavado broncoalveolar en niños inmunodeprimidos: rendimiento y complicaciones
Utility of Bronchoalveolar Lavage in Immunocompromised Children: Diagnostic Yield and Complications
L.E. Vega-Briceñoa,
, N.L. Holmgrena, P. Bertranda, J.I. Rodríguezb, F. Barrigac, I. Contrerasa, I. Sáncheza
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
Correspondencia: Sección de Respiratorio Pediátrico. Departamento de Pediatría.Pontificia Universidad Católica de Chile. Lira, 85, 5.° piso, Laboratorio de respiratorio. Santiago de Chile. Chile
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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"apellidos" => "Barriga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "I." "apellidos" => "Contreras" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "I." "apellidos" => "Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Respiratorio Pediátrico. Departamento de Pediatría. Pontificia Universidad Católica de Chile. Santiago de Chile" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos Pediátricos. Departamento de Pediatría. Pontificia Universidad Católica de Chile. Santiago de Chile" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección de Oncología Pediátrica. Departamento de Pediatría. Pontificia Universidad Católica de Chile. Santiago de Chile. Chile" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Sección de Respiratorio Pediátrico. Departamento de Pediatría.Pontificia Universidad Católica de Chile. Lira, 85, 5.° piso, Laboratorio de respiratorio. Santiago de Chile. Chile" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Utility of Bronchoalveolar Lavage in Immunocompromised Children: Diagnostic Yield and Complications" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-01-27" "fechaAceptado" => "2004-03-09" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec190045" "palabras" => array:4 [ 0 => "Lavado broncoalveolar" 1 => "Fibrobroncoscopia" 2 => "Niños" 3 => "Inmunodeficiencia" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec190046" "palabras" => array:4 [ 0 => "Bronchoalveolar lavage" 1 => "Fiberoptic bronchoscopy" 2 => "Children" 3 => "Immunodeficiency" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Material Y Método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Material And Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary infection in the immunocompromised host" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.M. Williams" 1 => "J.S. Remington" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am Rev Resp Dis" "fecha" => "1976" "volumen" => "114" "paginaInicial" => "259" "paginaFinal" => "264" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 4 | 6 |
| 2024 October | 43 | 24 | 67 |
| 2024 September | 43 | 18 | 61 |
| 2024 August | 46 | 33 | 79 |
| 2024 July | 32 | 30 | 62 |
| 2024 June | 59 | 21 | 80 |
| 2024 May | 45 | 29 | 74 |
| 2024 April | 29 | 27 | 56 |
| 2024 March | 41 | 34 | 75 |
| 2024 February | 32 | 40 | 72 |
| 2023 December | 0 | 2 | 2 |
| 2023 November | 0 | 2 | 2 |
| 2023 October | 0 | 10 | 10 |
| 2023 September | 0 | 4 | 4 |
| 2023 August | 0 | 1 | 1 |
| 2023 July | 0 | 2 | 2 |
| 2023 June | 0 | 1 | 1 |
| 2023 March | 2 | 0 | 2 |
| 2023 February | 40 | 17 | 57 |
| 2023 January | 25 | 30 | 55 |
| 2022 December | 31 | 34 | 65 |
| 2022 November | 39 | 20 | 59 |
| 2022 October | 25 | 21 | 46 |
| 2022 September | 36 | 25 | 61 |
| 2022 August | 37 | 37 | 74 |
| 2022 July | 25 | 32 | 57 |
| 2022 June | 28 | 38 | 66 |
| 2022 May | 32 | 25 | 57 |
| 2022 April | 48 | 33 | 81 |
| 2022 March | 54 | 34 | 88 |
| 2022 February | 57 | 21 | 78 |
| 2022 January | 33 | 27 | 60 |
| 2021 December | 22 | 34 | 56 |
| 2021 November | 28 | 42 | 70 |
| 2021 October | 34 | 62 | 96 |
| 2021 September | 26 | 48 | 74 |
| 2021 August | 15 | 44 | 59 |
| 2021 July | 35 | 38 | 73 |
| 2021 June | 32 | 46 | 78 |
| 2021 May | 15 | 35 | 50 |
| 2021 April | 40 | 66 | 106 |
| 2021 March | 42 | 36 | 78 |
| 2021 February | 39 | 20 | 59 |
| 2021 January | 18 | 23 | 41 |
| 2020 December | 19 | 20 | 39 |
| 2020 November | 21 | 14 | 35 |
| 2020 October | 13 | 9 | 22 |
| 2020 September | 20 | 6 | 26 |
| 2020 August | 26 | 17 | 43 |
| 2020 July | 20 | 18 | 38 |
| 2020 June | 25 | 12 | 37 |
| 2020 May | 17 | 18 | 35 |
| 2020 April | 24 | 5 | 29 |
| 2020 March | 22 | 19 | 41 |
| 2020 February | 30 | 15 | 45 |
| 2020 January | 42 | 21 | 63 |
| 2019 December | 38 | 30 | 68 |
| 2019 November | 21 | 16 | 37 |
| 2019 October | 11 | 21 | 32 |
| 2019 September | 25 | 26 | 51 |
| 2019 August | 21 | 29 | 50 |
| 2019 July | 30 | 25 | 55 |
| 2019 June | 24 | 11 | 35 |
| 2019 May | 51 | 33 | 84 |
| 2019 April | 35 | 31 | 66 |
| 2019 March | 19 | 32 | 51 |
| 2019 February | 21 | 21 | 42 |
| 2019 January | 20 | 27 | 47 |
| 2018 December | 24 | 29 | 53 |
| 2018 November | 33 | 40 | 73 |
| 2018 October | 44 | 33 | 77 |
| 2018 September | 20 | 13 | 33 |
| 2018 August | 1 | 0 | 1 |
| 2018 May | 9 | 2 | 11 |
| 2018 April | 1 | 2 | 3 |
| 2018 March | 8 | 8 | 16 |
| 2018 February | 11 | 15 | 26 |
| 2018 January | 6 | 9 | 15 |
| 2017 December | 6 | 11 | 17 |
| 2017 November | 11 | 9 | 20 |
| 2017 October | 14 | 13 | 27 |
| 2017 September | 7 | 8 | 15 |
| 2017 August | 26 | 9 | 35 |
| 2017 July | 15 | 12 | 27 |
| 2017 June | 13 | 13 | 26 |
| 2017 May | 11 | 7 | 18 |
| 2017 April | 9 | 6 | 15 |
| 2017 March | 19 | 7 | 26 |
| 2017 February | 4 | 3 | 7 |
| 2017 January | 9 | 8 | 17 |
| 2016 December | 15 | 6 | 21 |
| 2016 November | 29 | 14 | 43 |
| 2016 October | 46 | 19 | 65 |
| 2016 September | 25 | 12 | 37 |
| 2016 August | 20 | 7 | 27 |
| 2016 July | 23 | 6 | 29 |
| 2016 June | 31 | 18 | 49 |
| 2016 May | 31 | 8 | 39 |
| 2016 April | 31 | 2 | 33 |
| 2016 March | 10 | 3 | 13 |
| 2016 February | 13 | 3 | 16 |
| 2016 January | 27 | 13 | 40 |
| 2015 December | 21 | 17 | 38 |
| 2015 November | 34 | 6 | 40 |
| 2015 October | 90 | 2 | 92 |
| 2015 September | 87 | 0 | 87 |
| 2015 August | 73 | 0 | 73 |
| 2015 July | 77 | 0 | 77 |
| 2015 June | 77 | 0 | 77 |
| 2015 May | 80 | 0 | 80 |
| 2015 April | 69 | 0 | 69 |
| 2015 March | 61 | 0 | 61 |
| 2015 February | 44 | 0 | 44 |
| 2015 January | 60 | 0 | 60 |
| 2014 December | 60 | 0 | 60 |
| 2014 November | 76 | 0 | 76 |
| 2014 October | 103 | 0 | 103 |
| 2014 September | 70 | 0 | 70 |
| 2014 August | 75 | 0 | 75 |
| 2014 July | 67 | 0 | 67 |
| 2014 June | 88 | 0 | 88 |
| 2014 May | 94 | 0 | 94 |
| 2014 April | 77 | 0 | 77 |
| 2014 March | 95 | 0 | 95 |
| 2014 February | 70 | 0 | 70 |
| 2014 January | 72 | 0 | 72 |
| 2013 December | 55 | 0 | 55 |
| 2013 November | 68 | 0 | 68 |
| 2013 October | 73 | 0 | 73 |
| 2013 September | 63 | 0 | 63 |
| 2013 August | 105 | 0 | 105 |
| 2013 July | 99 | 0 | 99 |
| 2013 June | 46 | 0 | 46 |
| 2013 May | 75 | 0 | 75 |
| 2013 April | 47 | 0 | 47 |
| 2013 March | 16 | 0 | 16 |
| 2000 January | 3784 | 0 | 3784 |
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