To determine the diagnostic yield, morbidity, mortality and therapeutic impact of open lung biopsy (OLB) in the mechanically ventilated, critically ill patients.
We retrospectively reviewed all patients with respiratory failure on mechanical ventilation with diffuse pulmonary infiltrates that underwent OLB between 1995-2002. Patient demographics, presenting symptoms, comorbidities, admission APACHE II and SAPS II scores were recorded. The diagnostic workup including bronchoalveolar lavage (BAL), high resolution CT scanning (HRCT), serology for autoimmune and vasculitic diseases were also recorded. Hospital course was assessed in terms of days on ventilation prior to the procedure and final hospital outcome. Peri-procedure lung injury was examined in each subject by documenting pre and post biopsy PaO2/FiO2 ratios, dynamic lung compliance and PEEP levels. The impact of histological diagnosis on the management was determined. Operative complications including bleeding, intraoperative hemodynamic instability and air leak were also reviewed.
Five female (41%) and seven male (58%) patients were identified over a period of five years. The mean age was 52 years (SD± 17). The Average ventilator-days before OLB were 12 (SD± 9). PaO2/FiO2 ratio, dynamic lung compliance and PEEP levels pre and post biopsy were not significantly different and had no impact on the outcome. Histological diagnosis was established in all 12 patients. OLB-guided alteration of therapy directly benefited 50% of the patients and contributed to withdrawal of unnecessary therapy in 16.6%. No major perioperative or intraoperative complications occurred. The final outcome in terms of overall patient mortality was 41% and 58% were successfully discharged home.CONCLUSIONS: We conclude OLB to be a safe procedure in mechanically ventilated critically ill patients. At present there are no clinical and biological parameters that can identify high-risk patients undergoing OLB.
OLB is a valuable diagnostic procedure that leads to significant changes in the management. These changes resulted in an improved outcome in our study population.
R. Ahmed, None.