The Utility of Open Lung Biopsy in Patients Requiring Mechanical Ventilation: Ventilator-dependent patients
Canver and Mentzer looked specifically at ventilator-dependent patients with diffuse idiopathic lung disease. They included interstitial pneumonitis and fibrosis as well as alveolitis as a specific diagnosis, thus recording a 100% specific diagnosis rate. A change in therapy was initiated in 67% of patients, a rate similar to the one used in this study. Overall mortality was 52%, which is lower than the overall mortality rate of 67% in our study. Other hospital mortality rates after open lung biopsy have been reported as 63%, 45%, and 52%. Gender, age, number of ventilatory days before open lung biopsy and after biopsy treatment, as in this study, did not influence survival. Associated illnesses, which were not quantified by Canver and Mentzer, did not influence survival, unlike the findings of this study.
Operative mortality and morbidity have been reported, respectively, as 0% and 9.6%, 1.5% and 22%, and 1.6% and 48%. These rates appear to be higher in ventilated patients. Operative mortality in the series of ventilator-dependent patients studied by Canver and Mentzer was not recorded, but a complication rate of 40% was documented. This rate was twice the rate found in our study. The open lung biopsy-related mortality rate for our patient population was 8.4%. All patients were severely ill with dysfunction in > 2 other organs. Based on the results of this study, these patients would not have been expected to survive, otherwise, because no patients with a similar number of organ dysfunctions survived. allergy relief
The requirement for mechanical ventilation within the first 72 h of admission has been associated with increased mortality. The mortality in this group of patients, all of whom had respiratory failure requiring mechanical ventilation, is much greater than that seen in other groups of patients, predominately those not receiving mechanical ventilation. This suggests that the need for mechanical ventilation leading up to or immediately after an open lung biopsy is predictive of increased mortality.