The relatively high sensitivity and specificity of open-lung biopsy (OLB) in chronic pulmonary diseases has made it a valuable diagnostic tool for those diseases.1
OLB is a surgical procedure requiring anesthesia and is associated with risks. Consequently, OLB is usually not considered a first-choice procedure in the diagnosis of most lung processes.
OLB has been previously used in ARDS to identify the acute pathologic process (diffuse alveolar damage),2–
and the ensuing fibroproliferative damage reported as ARDS progresses.3
In addition, OLB has been used when less invasive technology (eg, transbronchial biopsy) fails to provide a diagnosis for a rapidly deteriorating patient with ARDS. Most patients with ARDS are receiving mechanical ventilation and are critically ill at the time of OLB. This increases the risk of morbidity and mortality associated with the procedure and explains, in part, the infrequent reports of OLB during ARDS.