The Utility of Open Lung Biopsy in Patients Requiring Mechanical Ventilation: Histological Diagnosis
Five patients (21%) had documented intraoperative complications. Four patients had documented hypoxia (defined as arterial oxygen saturation < 90%), and one patient had hypotension requiring the introduction of inotropes.
Postoperative complications occurred in 17% of the subjects. All such patients had persistent air leaks. One also had excessive postoperative bleeding, requiring an emergency reoperation for hemorrhage control; soon after, the patient died in ICU from irreversible shock. One patient died on the 5th postoperative day while on positive pressure ventilation from a tension pneumothorax on the side of the thoracotomy for the open lung biopsy.
Open lung biopsy provided a specific diagnosis in 46% and a nonspecific diagnosis in 46% of the patients. Five patients, in whom a previous fiberoptic bronchoscopy had shown what was considered to be a specific pathogenic organism, had nonspecific findings on biopsy read more allergies pills. A nonspecific histological finding was considered to be one showing various stages of an acute lung injury. Two patients, who had received bleomycin 2 and 3 weeks before presentation, were thought to have histological evidence for drug-related lung injury.
Histology was interpreted as normal in two patients (8.3%). In one of these patients, subsequent histology at autopsy, 3 days later, confirmed desquamative interstitial pneumonitis. The other patient had aspergillus pneumonia that was diagnosed 3 weeks after the open lung biopsy and a high-resolu-tion CT scan of the chest suggestive of bronchiolitis obliterans. The latter patient was not considered as an open lung biopsy misdiagnosis in this study.
Open lung biopsy findings directed a change of therapy for 18 patients (75%). Seven patients (29%) had a histologically based replacement of their antimicrobial therapy. Table 4 shows the open lung biopsy diagnosis, the open lung biopsy specific treatment, and corresponding cause of death.
Table 4—Histological Diagnosis, Subsequent Treatment and Patient Outcome
|Open Lung Biopsy-|
|Histology||Directed Treatment||Outcome, Cause of Death|
|Normal (n = 2)*||None||MSOF, aspergillus brain abscess|
|Specific diagnosis (n = 11)j|
|Viral infection (n = 2)||Nebulized riboviran||Both died of MSOF|
|Fungal infection (n = 2)||Amphotericin||Both survived|
|Pulmonary emboli (n = 1)||Anticoagulation||Survived|
|Disseminated malignancy (n = 1)||Nil (withdrawal)||Respiratory failure|
|Malignant histiocytosis (n = 1)||Steroids and chemotherapy||MSOF|
|Idiopathic pulmonary fibrosis (n = 1)||Steroids||Survived|
|Interstitial emphysema (n = 1)||Steroids (n = 2)||Respiratory failure|
|Bleomycin toxicity (n = 2)||Steroids (n = 2) [withdrawal (n = 1)]||Respiratory failure (n = 2)|
|Nonspecific diagnosis (n = 11)||Steroids (n = 7)|||MSOF (n = 2)Cerebral infarction (n = 1)|
|Open lung biopsy complication (n = 1)|
|None (n = 4)§|
|Cerebral hemorrhage (n = 1)|
|MSOF (n = 2)|