BACKGROUND: The utility of open lung biopsy (OLB) in mechanically ventilated patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) of unknown origin has been questioned because of its potentially low diagnostic yield and possibly related morbidity. To quantify possible benefits and risks, and especially so for bedside lung biopsy, we reviewed retrospectively our 8-year, single unit experience with this procedure. METHODS: Mechanically ventilated, critically ill patients with acute respiratory failure of unknown origin who underwent OLB were analyzed in a retrospective, single-center, cohort study in a medical intensive care unit in a university medical center. MEASUREMENTS AND MAIN RESULTS: Twenty-seven patients were analyzed (15 female, 12 male, of mean 48 years [standard deviation, 14]), 67% of whom were immunocompromised. All patients underwent bronchoscopy and bronchoalveolar lavage before OLB. PaO2/Fraction of inspired oxygen at the time of biopsy was 188 +/- 109 mm Hg. Biopsies were performed in the operating room on 9 patients and at bedside on 18. A specific diagnosis was obtained in 70% of biopsies. Biopsy results led to alteration in treatment in 81% of patients. Minor complications occurred in 52% of patients and major complications in 7%. The rate of complications did not appear to differ with the location of the procedure (bedside vs operating room). No deaths were attributed to the procedure. CONCLUSIONS: Bedside OLB can be performed safely in selected, mechanically ventilated, critically ill patients with ALI or ARDS. Our results support the concept that lung biopsy often leads to management alterations in patients where a standardized diagnostic workup failed to yield a definitive diagnosis.
BACKGROUND: The utility of open lung biopsy (OLB) in mechanically ventilated patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) of unknown origin has been questioned because of its potentially low diagnostic yield and possibly related morbidity. To quantify possible benefits and risks, and especially so for bedside lung biopsy, we reviewed retrospectively our 8-year, single unit experience with this procedure. METHODS: Mechanically ventilated, critically illpatients with acute respiratory failure of unknown origin who underwent OLB were analyzed in a retrospective, single-center, cohort study in a medical intensive care unit in a university medical center. MEASUREMENTS AND MAIN RESULTS: Twenty-seven patients were analyzed (15 female, 12 male, of mean 48 years [standard deviation, 14]), 67% of whom were immunocompromised. All patients underwent bronchoscopy and bronchoalveolar lavage before OLB. PaO2/Fraction of inspired oxygen at the time of biopsy was 188 +/- 109 mm Hg. Biopsies were performed in the operating room on 9 patients and at bedside on 18. A specific diagnosis was obtained in 70% of biopsies. Biopsy results led to alteration in treatment in 81% of patients. Minor complications occurred in 52% of patients and major complications in 7%. The rate of complications did not appear to differ with the location of the procedure (bedside vs operating room). No deaths were attributed to the procedure. CONCLUSIONS: Bedside OLB can be performed safely in selected, mechanically ventilated, critically illpatients with ALI or ARDS. Our results support the concept that lung biopsy often leads to management alterations in patients where a standardized diagnostic workup failed to yield a definitive diagnosis.
Authors: Claude Guerin; Frédérique Bayle; Véronique Leray; Sophie Debord; Alina Stoian; Hodane Yonis; Jean-Baptiste Roudaut; Gael Bourdin; Mojgan Devouassoux-Shisheboran; Elodie Bucher; Louis Ayzac; Sylvie Lantuejoul; Carole Philipponnet; Jean Louis Kemeny; Bertrand Souweine; Jean-Christophe Richard Journal: Intensive Care Med Date: 2014-12-05 Impact factor: 17.440
Authors: Marcos J Las Heras; Jose Dianti; Manuel Tisminetzky; Graciela Svetliza; Sergio E Giannasi; Eduardo San Roman Journal: J Intensive Care Soc Date: 2019-05-07
Authors: Hans Jörg Baumann; Hans Klose; Marcel Simon; Tarik Ghadban; Stephan A Braune; Jan K Hennigs; Stefan Kluge Journal: Crit Care Date: 2011-07-27 Impact factor: 9.097
Authors: Joerg Schreiber; Axel Nierhaus; Eik Vettorazzi; Stephan A Braune; Daniel P Frings; Yogesh Vashist; Jakob R Izbicki; Stefan Kluge Journal: Crit Care Date: 2014-06-16 Impact factor: 9.097