Chest
Volume 115, Issue 3, March 1999, Pages 811-817
Journal home page for Chest

Clinical Investigations in Critical Care
The Utility of Open Lung Biopsy in Patients Requiring Mechanical Ventilation

https://doi.org/10.1378/chest.115.3.811Get rights and content

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, Pao2/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 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%.

Section snippets

Materials and Methods

A retrospective review was conducted of medical case records of patients admitted to an adult university-affiliated tertiary referral ICU during the period of 1985 to 1995. Inclusion criteria were patients with ventilator-dependent respiratory failure and nonspecific radiological pulmonary interstitial infiltrates who had undergone open lung biopsy. This included patients already receiving mechanical ventilation and those admitted to the ICU for mechanical ventilation. Patients who had

Results

Open lung biopsy was an infrequently performed procedure with a yearly incidence of 0 to 0.9% of patient admissions to the ICU. Twenty-four patients were identified who fulfilled the study criteria. The mean age (± SD) was 48.9 ± 16.1 years.

All patients were receiving antimicrobial medications before the open lung biopsy. Seventeen patients (71%) were immunosuppressed at the time of the open lung biopsy. The median number of other organ failures was one other organ. The mean pao2/fraction of

Discussion

Open lung biopsy established a specific diagnosis in 46% of the patients in this series, all of whom were critically ill and with ventilator-dependent respiratory failure. As a result of the findings from the open lung biopsy, alteration in therapy (including withdrawal of therapy) occurred in 75% of the patients, and of these, 39% survived. Another 11% benefited from the avoidance of unnecessary, prolonged, and futile therapy. No patient with ≥ 2 other organ failures benefited from an

References (23)

  • HW Haverkos et al.

    Diagnosis of pneumonitis in immunocompromised patients by open lung biopsy

    Cancer

    (1983)
  • Cited by (55)

    • Invasive diagnostic strategies in immunosuppressed patients with acute respiratory distress syndrome

      2014, Clinics in Chest Medicine
      Citation Excerpt :

      The only factor independently associated with complications was high minute ventilation. Overall, the diagnostic yield of OLB, not specifically addressing immunocompromised patients, ranges between 44% and 80% and leads to changes in therapy in 44% to 91% of cases, with a reported complication rate between 7% and 52%, even in patients with severe oxygenation impairment (Table 1).44–51 Malignancies and rheumatologic diseases are conditions that warrant the use of cytotoxic therapy aimed at achieving control of neoplastic disease or antiinflammatory effect.

    • Role of Lung Biopsy in Diffuse Lung Disease

      2010, Medical Management of the Thoracic Surgery Patient
    • Role of Lung Biopsy in Diffuse Lung Disease

      2009, Medical Management of the Thoracic Surgery Patient
    View all citing articles on Scopus
    View full text