The Utility of Open Lung Biopsy in Patients Requiring Mechanical Ventilation
The desire to obtain a definitive diagnosis to optimize medical treatment has increased the demand for early, more invasive, and costly investigative procedures. Open lung biopsy is regarded as the gold standard for the diagnosis of pulmonary infiltrates, and several studies have documented its use in specific patient populations.
A complete history, physical examination, chest radiography, sputum cytology, and cultures will provide a reliable diagnosis in about 30% of patients.
Fiberoptic bronchoscopic investigations provide a diagnosis in 38% to 85% of patients according to the classification of histological findings. In comparison, the reported diagnostic yield of open lung biopsy ranges from 80% to 94%.
The decision for an open lung biopsy in critically ill patients is based on the need to make a specific diagnosis, and thereby direct specific treatment, withhold potentially ineffectual and/or harmful empirical treatment, or provide important prognostic information Click Here viagra super active plus.
Because the relative risk of the procedure must be balanced by the net benefit for the patient, accurate information about the clinical utility of the open lung biopsy in critically ill patients is essential. In predominately noncritically ill patients the clinical utility of the open lung biopsy remains controversial as to whether it does,- or does not, influence mortality for those in whom a specific diagnosis is made, The aim of this study was to determine the diagnostic yield, morbidity, mortality, and influence on subsequent treatment of open lung biopsy in patients with ventilator-dependent respiratory failure associated with bilateral pulmonary infiltrates.
Materials and Methods
A retrospective review was conducted of medical case records of patients admitted to an adult university-affiliated tertiary referral ICU during the period of 1985 to 1995. Inclusion criteria were patients with ventilator-dependent respiratory failure and nonspecific radiological pulmonary interstitial infiltrates who had undergone open lung biopsy. This included patients already receiving mechanical ventilation and those admitted to the ICU for mechanical ventilation. Patients who had therapeutic thoracotomies and incidental open lung biopsy were excluded. Ethical approval for this study was granted by the Royal Adelaide Hospital Human Ethics Committee.