The information obtained included the following: demographic data, data taken before (Table 1) and after (Table 2) open lung biopsy, open lung biopsy histological diagnosis, open lung biopsy-initiated treatment changes and resultant outcome, cause of death, and hospital outcome.
The extent of organ failure, other than respiratory, at the time leading up to open lung biopsy was determined based on previously established criteria defined in Table 3.
Immunosuppression was defined as a blood white-cell count of < 500/mm or the use of steroids for longer than 7 days.
The open lung biopsies were performed in an operating theater under general anesthesia. Access to the lung was via an anterior mini-thoracotomy. Sampling sites were selected based on radiologically affected sites and/or the lingula. A maximum of two tissue samples were obtained. All patients had one or two underwater seal drains in situ postoperatively. All operative lung samples were sent for Gram’s staining and bacteriological, viro-logical, and histological analysis Source canadian health mall. Sampling sites were not used as a variable for analysis, because those sites sampled had been well documented in terms of their efficacy.
Statistical analysis of the data was carried out using descriptive statistics for the ratio data and the x2 test for nominal data and non-normally distributed data. Mean, SD, and 95% confidence intervals (CIs) were determined. Analysis was performed by the computerized statistical software package Minitab v 8 (Minitab Inc; Philadelphia, PA).
Results
Open lung biopsy was an infrequently performed procedure with a yearly incidence of 0 to 0.9% of patient admissions to the ICU. Twenty-four patients were identified who fulfilled the study criteria. The mean age (± SD) was 48.9 ± 16.1 years.
Table 1—Patient Demographics

Age, yr Gender Admission Diagnosis Before Open Lung Biopsy Fio2/Pao2 Before Open Lung Biopsy Ventilation Other Organ Failure
72 F Atypical pneumonia 225 Yes 0
65 F Hematological malignancy 150 No 1
53 F Atypical pneumonia 112 Yes 3
64 M Atypical pneumonia 112 No 2
64 M Atypical pneumonia 150 No 1
31 F Hematological malignancy 150 No 3
28 F Atypical pneumonia 225 Yes 1
27 F Atypical pneumonia 150 Yes 3
49 F Atypical pneumonia 150 No 1
71 M Atypical pneumonia 112 Yes 0
28 F Atypical pneumonia 180 No 1
26 M Atypical pneumonia 285 No 0
45 F Hematological malignancy 150 Yes 3
67 F Atypical pneumonia 100 Yes 2
58 F Atypical pneumonia 112 Yes 0
48 F Atypical pneumonia 128 Yes 4
30 M Seminoma 128 Yes 4
59 M Atypical pneumonia 90 Yes 2
63 F Congestive cardiac failure 128 Yes 1
32 F Metastatic breast carcinoma 180 No 1
66 M Atypical pneumonia 100 No 0
44 M Hematological malignancy 100 No 1
52 F Atypical pneumonia 150 Yes 1
31 F Septicaemia, myelodysplasia 225 Yes 1

Table 2—Patient Characteristics for Survivors and Nonsurvivors

Patient Characteristics Survivors(n = 8) Nonsurvivors (n = 16) p Value
Age, yr 48.5 (± 17)* 49.1 (± 16.2)* 0.94
Immunosuppressed 25% 31% 0.75
Pa02/Fi0£ before open lung biopsy 158 (95% CI, 119-199) 145 (95% CI, 118-172) 0.53
Ventilation before open lung biopsy 50% 63% 0.56
Median number of other organ failure 1 2 0.05
Pa02/Fi02 differences before/after open lung biopsy -3 (95% CI, -27-21) -14 (95% CI, 42-14) 0.52
Complications during open lung biopsy 25% 7% 0.19
Complications after open lung biopsy 25% 13% 0.44
Open lung biopsy histology
Specific or normal 63% 44% 0.40
Nonspecific 37% 56%
Open lung biopsy-initiated treatment change 88% 63% 0.20

Table 3—Multiple Organ Dysfunction Criteria

Organ Criteria*
Respiratory Pao/Fio2 < 250
Positive end-expiratory pressure > 5 cmh2o
Need for mechanical ventilation
Cardiovascular MAP < 80 mm Hg
Inotropic drugs required to maintain MAP> 80 mm Hg
Cardiac index < 2.0 L/m2
Hepatic Total bilirubin > 60 mmol/L (in the absence of hemolysis)
Hepatic encephalopathy
International normalized ratio > 1.6
Hematological Platelets < 50,000/mm
Leukocytes < 500/mm
Hemoglobin < 10 g/dL (and/or requiring transfusion to support this level in the absence of blood loss)
Evidence of disseminated intravascular coagulation (fibrinogen < 1 g/L and elevated D-dimer levels)
Neurological Glasgow Coma Scale < 8 in the absence of sedative drugs
Renal Serum creatinine > 240 mmol/L
Need for dialysis or ultrafiltration