Utilization of open lung biopsy in patients with acute respiratory failure and diffuse pulmonary infiltrates Utilização da biópsia pulmonar a céu aberto em pacientes com insuficiência respiratória aguda e infiltrado pulmonar difuso*

Objective: The goal of this study was to better define the frequency of unexpected diagnoses made by open lung biopsy, the frequency with which biopsy results lead to a change in clinical management, and the frequency of procedural complications in patients with diffuse pulmonary infiltrates requiring mechanical ventilation. Methods: This is an observational, non-controlled study, with prospective collection of medical records of patients admitted to adult ICUs in Joinville/SC during the period from 1996 to 2004. Inclusion criteria were patients with ventilator-dependent respiratory failure and nonspecific radiological interstitial pulmonary infiltrates who had undergone open lung biopsy. Results: Thirty-five patients who fulfilled the study criteria were identified. Sixteen patients (45.7%) were immunosuppressed and nineteen (54.3%) patients had no previous immunosuppression history at the time of open lung biopsy. Open lung biopsy provided a specific diagnosis in 88.5% of patients and findings led to a change in therapy in 77.1%. Overall mortality was 62.8%, and among immunocompetent patients the mortality rate was 52% versus 75% for the immunosuppressed. Open lung biopsy-guided change of therapy directly benefited 87.5% of immunosuppressed and 68.4% of nonimmunosuppressed patients. Postoperative complications occurred in 14.2% of subjects. Conclusion: Despite the fact that open lung biopsy guided specific changes in therapy, the higher mortality rate may be due to the procedure being performed late, only after ten days in the ICU.