PURPOSE:We sought to determine the diagnostic yield, therapeutic impact and related morbidity and mortality of surgical lung biopsy SLB among patients with acute lung injury ALI or acute respiratory distress syndrome ARDS.
METHODS:In this retrospective cohort study.We included patients who underwent SLB and were adult, mechanically ventilated and admitted to the intensive care unit ICU with diagnosis of ALI or ARDS.
RESULTS:During study period, 15 patients (7 females,8 males) met our inclusion criteria. Mean age was 58.6(range 23–83).Median mechanical ventilation duration and hospital length of stay were 14 and 18 days respectively .Bronchoscopy was performed prior to SLB in 12(80%) patients.SLB was performed after median 4 days of mechanical ventilation. Open technique O-SLB was used in 9(60%) patients whereas Video Assisted Thoracoscopy VATS-SLB was performed in 6(40%). The top three SLB diagnoses were diffuse alveolar damage 5(33.3%), bacterial pneumonia 4(26.7) and Usual Interstitial Pneumonia 2(13.3%). SLB led to change in management of 4 patients (26.7%), which consisted of initiation of systemic corticosteroids in 3 patients and intravenous immunoglobulins in one.Prior to SLB, 7(46.7%) patients were already on systemic corticosteroids . After SLB, chest thoracostomy tube was kept for median of 5 days. Only 5(33.3%) patients died during ICU stay, none of them had persistent air leak. There was a trend toward higher median PaO2/FIO2 after SLB (129.4 vs. 151.3; p =0.09). Mortality rate was higher among patients with O-SLB than VATS-SLB (44.4% vs. 16.7%);however this did not reach statistical significance.
CONCLUSION:SLB established specific diagnosis in minority of patients and lead to management change in 26.7% of patients,mainly systemic corticosteroids. SLB did not result in increased morbidity or mortality. O-SLB was associated with higher mortality, although the association was not statistically significant.
CLINICAL IMPLICATIONS:Although SLB appears to be safe, it did not lead to major alteration in management. Our Study is limited by small sample size. Further studies are necessary to establish specific indications for this procedure that will impact clinical decision making.
DISCLOSURE:Tareq Zaza, No Financial Disclosure Information; No Product/Research Disclosure Information