MORBIDITY AND MORTALITY OF OPEN LUNG-BIOPSY IN CHILDREN

Objective. In patients with diffuse pulmonary infiltrates, when empiri c therapy or less-invasive diagnostic procedures fail, physicians freq uently resort to open lung biopsy (GLIB) to provide a definite diagnos is and to help redirect therapeutic treatment. OLB is still widely reg arded as a safe diagnostic procedure, even in the critically ill child . The objective of this study is to evaluate the accuracy of this view with regard to children with acute respiratory failure (ARF) and, for this purpose, compares the mortality and morbidity of such patients w ith those without ARF. Design. Retrospective chart review. Setting. Un iversity hospital. Patients. Forty-two patients (mean age, 6.6 years) underwent 47 OLBs for undiagnosed diffuse pulmonary infiltrates betwee n Bury 1984 and December 1994. Twenty-six patients (55%) were in ARF. Fifteen of these patients were intubated and receiving mechanical vent ilatory support before the OLB procedure. Results. The overall inciden ce of serious complications associated with the OLB procedure was 51%. Of the patients with ARF, 17 (65%) had at least one major complicatio n compared with 3 (14%) of the patients without ARF. pleural air compl ications (62% of the total) occurred only in patients with ARF: pneumo thoraces and/or prolonged air leaks developed in 10 (38%) after their OLBs; 9 of these patients died, and 7 had pneumothorax complicating th eir chest tube removal, which required replacement chest tubes. All pa tients with ARF preoperatively required prolonged ventilatory support after the OLB procedure, whereas 90% of the patients without ARF could be extubated within 24 hours. Overall, 10 patients (24%) died after t he OLB procedure. All deaths occurred in patients with ARF. Both ARF p reoperatively and the presence of postoperative complications were sig nificantly associated with decreased survival. Conclusions. The morbid ity and mortality rates of children with ARF undergoing OLB for diffus e pulmonary infiltrates differ considerably from those of children wit hout ARF. For children with ARF, OLB is associated with the risk of pr olonged ventilatory support, recurrent pneumothoraces, and air leaks. These complications may be attributable to such patients' having disea sed lungs with poor healing. Moreover, these complications may, in tur n, contribute to the patients' poor outcomes.