Einstein (São Paulo) (Jun 2004)
Utilization of open lung biopsy in patients with acute respiratory failure and diffuse pulmonary infiltrates
Abstract
Objective: The goal of this study was to better define the frequencyof unexpected diagnoses made by open lung biopsy, the frequencywith which biopsy results lead to a change in clinical management,and the frequency of procedural complications in patients withdiffuse pulmonary infiltrates requiring mechanical ventilation.Methods: This is an observational, non-controlled study, withprospective collection of medical records of patients admitted toadult ICUs in Joinville/SC during the period from 1996 to 2004.Inclusion criteria were patients with ventilator-dependentrespiratory failure and nonspecific radiological interstitialpulmonary infiltrates who had undergone open lung biopsy. Results:Thirty-five patients who fulfilled the study criteria were identified.Sixteen patients (45.7%) were immunosuppressed and nineteen(54.3%) patients had no previous immunosuppression history atthe time of open lung biopsy. Open lung biopsy provided a specificdiagnosis in 88.5% of patients and findings led to a change intherapy in 77.1%. Overall mortality was 62.8%, and amongimmunocompetent patients the mortality rate was 52% versus75% for the immunosuppressed. Open lung biopsy-guided changeof therapy directly benefited 87.5% of immunosuppressed and 68.4%of nonimmunosuppressed patients. Postoperative complicationsoccurred in 14.2% of subjects. Conclusion: Despite the fact thatopen lung biopsy guided specific changes in therapy, the highermortality rate may be due to the procedure being performed late,only after ten days in the ICU.
