SAFETY AND YIELD OF TRANSBRONCHIAL BIOPSY IN MECHANICALLY VENTILATED PATIENTS

Objective: To evaluate the safety and diagnostic yield of transbronchi al biopsy performed in mechanically ventilated patients. Design: Retro spective, cohort analysis. Setting: A university-affiliated teaching h ospital. Patients: Seventy one consecutive, mechanically ventilated pa tients requiring lung tissue examination. Interventions: Transbronchia l lung biopsy. Measurements and Main Results: We evaluated complicatio ns associated with transbronchial biopsy, diagnostic yield of the proc edure, and changes in patient management based on the results of the t ransbronchial lung biopsies, Eighty-three transbronchial lung biopsy p rocedures were performed in this patient cohort, Complications associa ted with these procedures included the following: ten (14.3%) pneumoth oraces in patients without preexisting chest tubes; five (6.0%) episod es of bronchial hemorrhage of >30 mL; transient oxygen desaturation to <90% in seven (8.4%) patients; hypotension with a mean arterial press ure of <60 mm Hg in six (7.2%) patients; and three (3.6%) episodes of tachycardia, with a heart rate of >140 beats/min, No patient deaths, e pisodes of pneumonia, or sepsis could be attributed to the transbronch ial lung biopsy procedures, Specific histologic diagnoses were made wi th 29 (34.9%) of the transbronchial biopsies, and patient management w as changed as a direct result of the lung tissue examination in 34 (41 .0%) instances, Pathologic correlation between the transbronchial biop sy specimens and lung tissue obtained by open-lung biopsy or post mort em examination occurred in 11 (84.6%) of 13 paired samples. Conclusion : Transbronchial lung biopsy can be performed with an acceptable risk and reasonable diagnostic yield in certain types of mechanically venti lated patients, often obviating the need to perform open-lung biopsy.