The utility of open lung biopsy in patients requiring mechanical ventilation.

STUDY OBJECTIVE To determine the diagnostic yield, morbidity, mortality, and therapeutic impact of the open lung biopsy in patients requiring mechanical ventilation. DESIGN Retrospective review of patient records. SETTING Tertiary ICU. PATIENTS Patients with respiratory failure and diffuse pulmonary infiltrates requiring mechanical ventilation, leading up to or following an open lung biopsy. MEASUREMENTS Information included patient demographics, organ failure, microbiological results before open-lung biopsy, Pao,/fraction of inspired oxygen values before and after biopsy, immunosuppression, timing of open lung biopsy, biopsy-related morbidity and mortality, duration of after-biopsy ventilation, open lung biopsy results, biopsy-initiated treatment alterations, and hospital outcome. RESULTS Twenty-four patients were identified. The mean age was 48.9 years (confidence interval, 42.1 to 55.7). Twenty-one percent had respiratory infections diagnosed before open lung biopsy but not confirmed by open lung biopsy. Intraoperative complications occurred in 21% of patients, and postoperative complications occurred in 17% of patients. Operative mortality was 8.4%. The specific and the nonspecific diagnostic rates were both 46%. Lung histology was normal in two patients; one of those patients had a false-negative finding. No patient with respiratory failure plus 2 2 other organ failures survived. Alteration of therapy did not differentiate between survivors. Open lung biopsy-guided alteration of therapy directly benefited 39%, and withdrawal was possible in 8.4% of the patients. CONCLUSIONS The multiple organ dysfunction score should be considered when deciding the relative risk of performing an open lung biopsy, which in this group of patients provided a specific diagnosis in 46% and carried a mortality rate of 8.4%.