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Clinical Investigations in Critical Care |

The Utility of Open Lung Biopsy in Patients Requiring Mechanical Ventilation*

Arthas Flabouris, MBBS; John Myburgh, MBBCh
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*From the Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.



Chest. 1999;115(3):811-817. doi:10.1378/chest.115.3.811
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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%.

Abbreviations: CI = confidence interval; Fio2 = fraction of inspired oxygen; MODS = multiple organ dysfunction score; MSOF = multisystem organ failure

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