The utility of open lung biopsy in critically ill adult patients

Introduction

Open lung biopsy (OLB) is regarded as the gold standard for the diagnosis of pulmonary infiltrates. This procedure is associated with significant risk of morbidity and mortality in the intensive care unit (ICU) setting. We wished to study the efficacy of open lung biopsies in ICU patients requiring advanced respiratory support associated with bilateral pulmonary infiltrates.

Methods

We reviewed medical case records of all patients who underwent open lung biopsy on the ICU between August 1996 and June 2003. We included patients requiring advanced ventilatory support, with persistent bilateral infiltrates on chest X-ray failing to respond to first-line treatment.

The biopsies were performed in the ICU at the University Hospital of Wales under general anaesthesia. Access to the lung was via anterior mini thoracotomy. All operative lung samples were sent for bacteriology Gram staining and culture, virology and histology assessment.

Results

We performed 13 OLBs in the study period. The patient demographics (survivors versus nonsurvivors) are presented in Table 1. Open lung biopsy provided a diagnosis in 12 out of 13 patients (92%). In all 12 of these patients specific treatment changes were implemented. Overall mortality was 53.8%.

Table 1

Conclusion

OLB in critically ill patients is an accurate diagnostic tool.