The utility of opera lung biopsy in patients requiring mechanical ventilation

Study objective: To determine the diagnostic yield, morbidity, mortality, a nd therapeutic impact of the open lung biopsy in patients requiring mechani cal ventilation, Design: Retrospective review of patient records. Setting: Tertiary ICU. Patients: Patients with respiratory failure and diffuse pulmonary infiltrates requiri ng mechanical ventilation, leading up to or following an open lung biopsy. Measurements: Information included patient demographics, organ failure, mic robiological results before open-lung biopsy, PaO2/fraction of inspired oxy gen values before and after biopsy, immunosuppression, timing of open lung biopsy, biopsy-related morbidity and mortality, duration of after-biopsy ve ntilation, open lung biopsy results, biopsy-initiated treatment alterations , and hospital outcome, Results: Twenty-four patients were identified, The mean age was 48.9 years (confidence interval, 42.1 to 55.7). Twenty-one percent had respiratory inf ections diagnosed before open lung biopsy but not confirmed by open lung bi opsy. Intraoperative complications occurred in 21% of patients, and postope rative complications occurred in 17% of patients. Operative mortality was 8 .4%. The specific and the nonspecific diagnostic rates were both 46%. Lung histology was normal in two patients; one of those patients had a false-neg ative finding. No patient with respiratory failure plus greater than or equ al to 2 other organ failures survived. Alteration of therapy did not differ entiate between survivors. Open lung biopsy-guided alteration of therapy di rectly benefited 39%, and withdrawal was possible in 8.4% of the patients. Conclusions: The multiple organ dysfunction score should be considered when deciding the relative risk of performing an open lung biopsy, which in thi s group of patients provided a specific diagnosis in 46% and carried a mort ality rate of 8.4%.