Open lung biopsy in children with respiratory failure

Objective: to evaluate benefits and risks of open lung biopsy in children w ith respiratory failure. Design: Retrospective chart review. Setting: A 36-bed pediatric critical care unit in a tertiary care, universi ty-based hospital. Patients: We studied 31 patients with respiratory failure who underwent 33 open lung biopsies. Measurements and Main Results: The charts of all children in the critical c are unit with respiratory failure who underwent an open lung biopsy over a 10-yr period (1989-98) were reviewed. Di 33 open lung biopsies performed, 7 6% (25 of 33) led to a relevant change in medical management. Complications were seen in 45% of patients, predominantly attributable to airleak (33%) without affecting respiratory function. An infectious agent was detected by open lung biopsy in ten patients; bronchoalveolar lavage performed before open lung biopsy failed to isolate the infection in eight of ten patients. Conclusions: In children with undiagnosed or persisting respiratory failure , open lung biopsy is a useful diagnostic procedure that leads to significa nt changes in medical management and increases the diagnostic yield for inf ections. Despite the relatively high complication rate, open lung biopsy sh ould be performed routinely in this group of patients.