Brief clinical reportYield and safety of bedside open lung biopsy in mechanically ventilated patients with acute lung injury or acute respiratory distress syndrome
Section snippets
Materials and methods
A retrospective analysis was conducted on adult patients admitted to the 12-bed medical ICU at the University Medical Center Hamburg-Eppendorf. From 1997 to 2005, a mean of 1,300 patients per year were treated, including a small portion of surgical patients. Using the terms thoracotomy and lung biopsy, the database containing all medical reports was screened for eligible patients. Patients with ventilator-dependent ALI or ARDS who underwent OLB were considered eligible if they were ventilator
Patient Characteristics
Between 1997 and 2005, 31 ICU patients underwent 31 OLB. Among these, 4 patients were excluded because OLB was obtained during a therapeutic thoracotomy (n = 1), intermittent noninvasive ventilation was applied before OLB (n = 1), and there was incomplete medical documentation (n = 2). Demographics are shown in Table I. According to the inclusion criteria, all 27 remaining patients were mechanically ventilated owing to ALI/ARDS for a median of 8 days (range, 2-76) before lung biopsy. Median
Discussion
The current study shows that bedside OLB is an appropriate and safe diagnostic procedure in a selected population of mechanically ventilated patients with ALI or ARDS of unknown origin. We were able to show that OLB was a decisive diagnostic step in a substantial proportion of patients, in whom (>70%) a standardized diagnostic workup including laboratory diagnostics, thoracic CT, and bronchoscopy with BAL failed to obtain a definitive diagnosis. Except for CMV, nearly no infectious agents were
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Cited by (42)
Complications of a lung biopsy for severe respiratory failure: A systematic review and meta-analysis
2023, Respiratory InvestigationCitation Excerpt :Among them, 13 studies (consisting of 574 patients) met the eligibility criteria and were included in the quality assessment and meta-analysis (Fig. 1). The characteristics of the included studies are presented in Table 1 and Table S3 [12–24]. No randomized controlled trial was identified.
ARDS clinical practice guideline 2021
2022, Respiratory InvestigationPathophysiology of acute fibrinous and organizing pneumonia – Clinical and morphological spectra
2019, PathophysiologyCitation Excerpt :Trans-bronchial lung biopsy can be performed with a reasonable diagnostic yield and an acceptable risk in mechanically ventilated patients. Open-lung biopsy in critically ill patients requiring MV usually is performed outside of the ICU but sometimes at the bedside [14]. Patients with lung disease of unknown etiology unresponsive to empirical treatment demand an accurate histological diagnosis for specific treatment prescription, since the clinical course seems influenced by the severity of the underlying disorder [15].
Acute respiratory distress syndrome
2016, The LancetCitation Excerpt :Small, single-centre observational studies of open lung biopsy in highly selected populations show low specificity of the clinical diagnosis of acute respiratory distress syndrome for the presence of diffuse alveolar damage.10–12,14 Most patients with acute respiratory distress syndrome undergoing this procedure have resulting alterations in management,10–12,73,74 improved outcomes,73 and little noteworthy morbidity.10–12,14,73,74 These studies are limited by their selective nature and their constrained ability to examine the entire lung.
The presence of diffuse alveolar damage on open lung biopsy is associated with mortality in patients with acute respiratory distress syndrome: A systematic review and meta-analysis
2016, ChestCitation Excerpt :Our meta-analysis included 8 datasets from 8 unique studies.19,23-29 According to the QUADAS score,21 4 studies were classified as higher19,24,26,27 and 4 as middle quality.23,25,28,29 No studies were classified as lower quality (Table 1).
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The first two authors contributed equally to this work.