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.
with respiratory failure and diffuse pulmonary infiltrates requiring
mechanical ventilation, leading up to or following an open lung
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.
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%.
CI = confidence interval; Fio2 = fraction
of inspired oxygen; MODS = multiple organ dysfunction score;
MSOF = multisystem organ failure