Evaluation of Open Lung Biopsy in Critically Ill, Ventilator Dependent Intensive Care Unit Patients

Abstract

OBJECTIVE: Evaluation of the benefits and risks of performing open lung biopsy (OLB) in critically ill, ventilator dependent intensive care unit patients.DESIGN: Retrospective chart review from 1990 to 1995.SETTING: A tertiary care teaching hospital intensive care unit.INTERVENTION: OLB in patients requiring mechanical ventilation for respiratory failure.MEASUREMENTS: Data collected included preoperative investigations, lung injury score, diagnosis, treatment and eventual outcome.RESULTS: Twenty-seven patients (14 male, 13 female) were mechanically ventilated before OLB for a median duration of seven days. A change in clinical management occurred in 85% of the patients as a result of new information obtained from the OLB. There was no statistical difference in overall outcome whether OLB was performed early or later in the course of respiratory failure once the patient was mechanically ventilated. The incidence of perioperative complications was 37%. Ten patients eventually left hospital.CONCLUSIONS: In a small percentage of intensive care patients refractory to the usual medical treatment modalities, open lung biopsy intervention is required to attempt to obtain a specific diagnosis.