Risks and benefits of open-lung biopsy in the mechanically ventilated critically ill population: a cohort study and literature review.

BACKGROUND

The study's objective was to determine the diagnostic yield, morbidity, mortality, and therapeutic impact of open-lung biopsy (OLB) in mechanically ventilated, critically ill patients.

MATERIAL/METHODS: The study was conducted as a retrospective cohort study in multidisciplinary ICU in a tertiary level academic center and included all patients with respiratory failure and diffuse pulmonary infiltrates who underwent OLB between 1996-2004. Patient demographics, presenting symptoms, co-morbidities, APACHEII and SAPS II scores, and the diagnostic work-up preceding OLB were recorded. Pre- and post-biopsy PaO(2)/FiO(2) ratios, lung compliance, and PEEP were documented. The impact of histological diagnosis on the management was determined. Operative complications including bleeding, intraoperative hemodynamic instability, and persistent air leak were also reviewed.

RESULTS

Fourteen patients were identified. The median ventilator time before OLB was 8.5 days. Nine patients were on inotropes and seven on renal replacement therapy at the time of biopsy. PaO(2)/FiO(2) ratio, lung compliance, and PEEP levels pre- and post-biopsy were not significantly different. Histological diagnoses were established in all 14 patients. Biopsy results led to the addition of a new therapy in 9 patients (64%) and the withdrawal of unnecessary therapy in 2 patients (14%). No major perioperative or intraoperative complications occurred. Six (43%) patients were discharged alive from the hospital.

CONCLUSIONS

Open-lung biopsy in mechanically ventilated critically ill patients provides significant diagnostic information leading to change in the management of the majority of patients. The procedure is well tolerated and associated with an acceptable benefit-to-risk ratio.