The Utility of Open Lung Biopsy in Patients Requiring Mechanical Ventilation: Results
All patients were receiving antimicrobial medications before the open lung biopsy. Seventeen patients (71%) were immunosuppressed at the time of the open lung biopsy. The median number of other organ failures was one other organ. The mean Pa02/ fraction of inspired oxygen (F102) ratio before open lung biopsy for this group of patients was 161, and 58% of patients were ventilated immediately before open lung biopsy, indicative of the severity of respiratory failure in this group of patients.
Respiratory infections were diagnosed in five patients (four bacterial and one fungal) 2 to 10 days before the open lung biopsy. All had received specific treatment for their infections but had failed to show improvement. Neither of these organisms were confirmed as pathogens contributing to the patient’s respiratory condition on the subsequent open lung biopsy. All other patients were recorded as having an undiagnosed cause for their respiratory failure.
Figure 1 shows the distribution of Pa02/Fl02 ratios before open lung biopsy and the maximal change in the ratio within the first postoperative 24-h period, Comparisons of patient characteristics and findings before and after open lung biopsy for survivors and nonsurvivors are shown in Table 2 Click Here canadianfamilypharmacy.
The time course, starting with hospital admission, fiberoptic investigation, then open lung biopsy, and discharge from ICU for survivors and nonsurvivors, did not differ and is illustrated in Figure 2. Three patients (13%) did not have a fiberoptic bronchoscopy as part of their respiratory diagnostic work-up, All three patients were in the nonsurvivor group.
Of the patient characteristics examined, the number of other organs involved was the only statistically significant feature to differentiate between survivors and nonsurvivors. Figure 3 shows the number of other organ failures and the associated causes of death. No patient with > 2 other organ failures survived, despite the results of the open lung biopsy. Multisystem organ failure (MSOF) was the predominant cause of death in those patients with a greater number of other organ dysfunctions.
Figure 1. Comparison of the before and after biopsy Pao2/Flo2 ratio for each patient. The mean change for survivors was —3.0 (95% CI, —26.7 to 20.7) and for nonsurvivors —13.8 (95% CI, —41.5 to 14.0) (p = 0.52). The mean difference for this group of patients was —10.2 (95% Ci, —29.3 to 8.9).
Figure 2. The mean length of stay from the time of hospital admission to the time of fiberoptic bronchoscope (FOB), to the time for open lung biopsy (OLB), and eventual discharge from the hospital is shown for survivors and nonsurvivors. The difference between the two groups was not statistically significant (p = 0.86).
Figure 3. Patient outcomes within each MODS group. The outcomes are expressed as a percentage for each group. No patient with MODS of > 2 survived.