Severe respiratory failure requiring ICU admission in bone marrow transplant recipients

Two groups of bone marrow transplant (BMT) recipients with febrile noncardi ogenic respiratory failure requiring intensive care unit (ICU) admission, i n the early phase of bone marrow transplantation were compared: those who h ad proven infectious pneumonia and those in whom bronchoalveolar lavage (BA L) failed to establish a diagnosis. Thirty-eight consecutive neutropenic BRIT recipients admitted to an ICU wit h febrile noncardiogenic respiratory failure were enrolled. All of them und erwent a BAL with viral, fungal, bacterial, and histopathological examinati ons. Lung biopsies were performed in nonsurviving patients in order to comp are with BAL results. Haematological, biological, respiratory failure and o ther organ failure parameters, infectious results, outcome, and lung biopsy results were evaluated. BAL allowed an infectious diagnosis to be established in 16 BRIT recipients . No aetiology was proven in 22 patients. Without a significant difference in respiratory failure parameters on ICU admission, noninvasive continuous positive airway pressure ventilation, which was given to 11 patients in eac h group, was significantly more successful in patients with proven infectio us pneumonia (6 of 11 versus 0 of 11 patients) and enabled endotracheal int ubation to be avoided in significantly more patients with infectious diseas e (10 of 16 venus 22 of 22 patients). The evolution of patients without dia gnosis was significantly different with more frequent renal failure, hepati c failure, and death (20 of 22 versus 9 of 16 patients). Post mortem biopsi es confirmed the absence of micro-organisms, but endothelial damage and fib rosis was found in 14 of the 22 patients. In conclusion, in the early phase of bone marrow transplantation the recipi ents without proven aetiology of pneumonia have a worse outcome than grafte d patients with proven infectiuous pneumonia.