Laura J Libby1, Brian D Gelbman2, Nasser K Altorki3, Paul J Christos4, Daniel M Libby2. 1. Divisions of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York. Electronic address: lj12003@nyp.org. 2. Divisions of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York. 3. Division of Thoracic Surgery, Department of Surgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York. 4. Department of Epidemiology and Biostatistics, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York.
Abstract
BACKGROUND: Adult respiratory distress syndrome (ARDS) has a high mortality rate and consumes considerable health care resources. It is not clear whether specimens obtained from open lung biopsy (OLB) in ARDS provide a specific diagnosis, alter therapy, or affect outcome. This meta-analysis attempts to determine whether OLB is safe, provides a specific diagnosis, changes therapy, or affects survival. METHODS: A computerized search was performed of Medline and PubMed from January 1988 to December 2012 of English language studies of acute respiratory failure and diffuse pulmonary infiltrates that evaluated OLB in primarily adult mechanically ventilated patients. Of 194 abstracts retrieved, 64 articles were reviewed; 130 articles were excluded because they did not evaluate OLB. After applying the selection criteria, 24 articles were included. RESULTS: OLB in ARDS provided a specific diagnosis in 84% of patients and altered management in 73%. Hospital mortality was 43%. The complication rate for OLB in ARDS was 22%, but death from OLB was rare. CONCLUSIONS: OLB in ARDS is a potentially productive procedure that provides a specific diagnosis and leads to a change in management in high proportions of patients. ARDS has a high mortality rate, which OLB does not appear to increase. Owing to a lack of randomized controlled trials, a survival advantage of OLB in ARDS could not be demonstrated.
BACKGROUND: Adult respiratory distress syndrome (ARDS) has a high mortality rate and consumes considerable health care resources. It is not clear whether specimens obtained from open lung biopsy (OLB) in ARDS provide a specific diagnosis, alter therapy, or affect outcome. This meta-analysis attempts to determine whether OLB is safe, provides a specific diagnosis, changes therapy, or affects survival. METHODS: A computerized search was performed of Medline and PubMed from January 1988 to December 2012 of English language studies of acute respiratory failure and diffuse pulmonary infiltrates that evaluated OLB in primarily adult mechanically ventilated patients. Of 194 abstracts retrieved, 64 articles were reviewed; 130 articles were excluded because they did not evaluate OLB. After applying the selection criteria, 24 articles were included. RESULTS: OLB in ARDS provided a specific diagnosis in 84% of patients and altered management in 73%. Hospital mortality was 43%. The complication rate for OLB in ARDS was 22%, but death from OLB was rare. CONCLUSIONS: OLB in ARDS is a potentially productive procedure that provides a specific diagnosis and leads to a change in management in high proportions of patients. ARDS has a high mortality rate, which OLB does not appear to increase. Owing to a lack of randomized controlled trials, a survival advantage of OLB in ARDS could not be demonstrated.
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: Nicolas de Prost; Tài Pham; Guillaume Carteaux; Armand Mekontso Dessap; Christian Brun-Buisson; Eddy Fan; Giacomo Bellani; John Laffey; Alain Mercat; Laurent Brochard; Bernard Maître Journal: Ann Intensive Care Date: 2017-06-19 Impact factor: 6.925