RESUMO
BACKGROUND: Bronchoscopy with bronchoalveolar lavage (BAL) and respiratory tract biopsies are important tools for diagnosing fungal infections in children with cancer and hematopoietic stem cell transplant (HSCT) recipients. Our objective was to evaluate the impact of BAL and respiratory tract biopsies on the management of suspected fungal infections in oncology and HSCT patients. PROCEDURE: We retrospectively reviewed the medical records of oncology and HSCT patients with possible, probable, or proven fungal infection of the respiratory tract and determined whether BAL or biopsy following computed tomography (CT) prompted a change in management. RESULTS: Among 101 patients (0.5-29 years of age), 24 underwent a BAL and 31 had biopsies (27 lung and 4 sinus). The remaining 46 patients had CT scans only. Of these, there were radiographic findings suggestive of a fungal infection in 38 patients (83%). Thirty of these 38 patients (79%) had a change in management. BAL provided a diagnosis in 6 of 24 patients (25%). There was a change in management in 2 of the 6 (33%). Respiratory tract biopsy provided a diagnosis in 12 of 31 patients (39%). Biopsy results led to a change in management in 4 of the 12 patients (33%). Significant postoperative morbidity attributed to biopsy occurred in 3 of 31 patients (10%); 2 patients had pneumothorax requiring chest tube and intubation and a patient had prolonged intubation. CONCLUSION: BAL and biopsy in children with an oncological diagnosis or those undergoing HSCT only infrequently lead to changes in management in the era of empiric therapy with broad-spectrum anti-fungal agents.
Assuntos
Biópsia/estatística & dados numéricos , Líquido da Lavagem Broncoalveolar/microbiologia , Micoses/diagnóstico , Infecções Respiratórias/diagnóstico , Adolescente , Adulto , Antifúngicos/uso terapêutico , Biópsia/efeitos adversos , Criança , Pré-Escolar , Gerenciamento Clínico , Substituição de Medicamentos , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Hospedeiro Imunocomprometido , Lactente , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/patologia , Masculino , Micoses/complicações , Micoses/tratamento farmacológico , Micoses/patologia , Neoplasias/complicações , Neoplasias/terapia , Infecções Oportunistas/complicações , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/patologia , Infecções Oportunistas/terapia , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/patologia , Estudos Retrospectivos , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/tratamento farmacológico , Sinusite/patologia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
PURPOSE: We tested home pain management for children for effects on pain intensity, analgesics administered, satisfaction, and use of healthcare services over 3 post-discharge days. DESIGN AND METHODS: In this quasi-experimental study with 108 children and their parents, we used the numeric rating scale or the Faces Pain Scale-Revised, calculated percentages of analgesics administered, and asked questions about expectations, satisfaction, and services. Between-group differences were tested with t-tests and analysis of variance. RESULTS: After home pain management for children, children reported moderate pain, and parents administered more analgesics on study days. Parents and children were satisfied; parents used few services. Written instructions and a brief interactive session were not sufficient to change parents' analgesic administration practices to relieve their children's pain. PRACTICE IMPLICATIONS: Further research is needed to develop and test effective education interventions to facilitate relief of children's postoperative pain.