The role of open lung biopsy in critically ill adult patients remains controversial. The aim of this study was to determine the diagnostic ability, mortality and therapeutic impact of open lung biopsy critical versus non-critically ill patients.
We conducted a retrospective review of all open lung biopsies performed at our institution for diagnostic indications in the last 5 years.
From January 2000-December 2004, 68 patients were identified who underwent open lung biopsy. Of these, 18 were critically ill (defined as requiring mechanical ventilation patients or requiring FiO2 =1.0 by face mask). Fifty patients were non-critically ill (defined as in-patient/out-patient referrals with FiO2 requirements <1.0). Therapeutic change, defined as addition of a new agent was made in 9/18 (50%) for critically ill patients, and in 25/50 (50%) non-critical patients. The operative mortality was 8/18 (44%) for the critical patients while it was 0/50 (0%) in the non-critical patients. Of the critical patients for whom a therapeutic change was initiated, 6/9 (67%) survived and were discharged.
Our results indicate that open lung biopsy in critically ill patients remains a high risk procedure with a high operative mortality. It does however have a diagnostic yield similar to that in non-critically ill patients.
Open lung biopsies continue to be a challenging problem in this difficult subset of patients. However, despite the significant inherent risks it may still be considered to direct a therapeutic change when other non-invasive modalities have been exhausted.
Kalpaj Parekh, None.