The utility of open lung biopsy in patients requiring mechanical ventilation.

Abstract

STUDY OBJECTIVE: To determine the diagnostic yield, morbidity, mortality, and therapeutic impact of the open lung biopsy in patients requiring mechanical ventilation. DESIGN: Retrospective review of patient records. SETTING: Tertiary ICU. PATIENTS: Patients with respiratory failure and diffuse pulmonary infiltrates requiring mechanical ventilation, leading up to or following an open lung biopsy. MEASUREMENTS: Information included patient demographics, organ failure, microbiological results before open-lung biopsy, Pao,/fraction of inspired oxygen values before and after biopsy, immunosuppression, timing of open lung biopsy, biopsy-related morbidity and mortality, duration of after-biopsy ventilation, open lung biopsy results, biopsy-initiated treatment alterations, and hospital outcome. RESULTS: Twenty-four patients were identified. The mean age was 48.9 years (confidence interval, 42.1 to 55.7). Twenty-one percent had respiratory infections diagnosed before open lung biopsy but not confirmed by open lung biopsy. Intraoperative complications occurred in 21% of patients, and postoperative complications occurred in 17% of patients. Operative mortality was 8.4%. The specific and the nonspecific diagnostic rates were both 46%. Lung histology was normal in two patients; one of those patients had a false-negative finding. No patient with respiratory failure plus 2 2 other organ failures survived. Alteration of therapy did not differentiate between survivors. Open lung biopsy-guided alteration of therapy directly benefited 39%, and withdrawal was possible in 8.4% of the patients. CONCLUSIONS: The multiple organ dysfunction score should be considered when deciding the relative risk of performing an open lung biopsy, which in this group of patients provided a specific diagnosis in 46% and carried a mortality rate of 8.4%.