title: Safety and yield of transbronchial biopsy in mechanically ventilated patients.
abstract: OBJECTIVE
  To evaluate the safety and diagnostic yield of transbronchial biopsy performed in mechanically ventilated patients.
  
  
  METHODS
  Retrospective, cohort analysis.
  
  
  METHODS
  A university-affiliated teaching hospital.
  
  
  METHODS
  Seventy-one consecutive, mechanically ventilated patients requiring lung tissue examination.
  
  
  METHODS
  Transbronchial lung biopsy.
  
  
  RESULTS
  We evaluated complications associated with transbronchial biopsy, diagnostic yield of the procedure, and changes in patient management based on the results of the transbronchial lung biopsies. Eighty-three transbronchial lung biopsy procedures were performed in this patient cohort. Complications associated with these procedures included the following: ten (14.3%) pneumothoraces in patients without preexisting chest tubes; five (6.0%) episodes of bronchial hemorrhage of > 30 mL; transient oxygen desaturation to < 90% in seven (8.4%) patients; hypotension with a mean arterial pressure of < 60 mm Hg in six (7.2%) patients; and three (3.6%) episodes of tachycardia, with a heart rate of > 140 beats/min. No patient deaths, episodes of pneumonia, or sepsis could be attributed to the transbronchial lung biopsy procedures. Specific histologic diagnoses were made with 29 (34.9%) of the transbronchial biopsies, and patient management was changed as a direct result of the lung tissue examination in 34 (41.0%) instances. Pathologic correlation between the transbronchial biopsy specimens and lung tissue obtained by open-lung biopsy or post mortem examination occurred in 11 (84.6%) of 13 paired samples.
  
  
  CONCLUSIONS
  Transbronchial lung biopsy can be performed with an acceptable risk and reasonable diagnostic yield in certain types of mechanically ventilated patients, often obviating the need to perform open-lung biopsy.
authors.affiliation: Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: O'Brien
authors.forename: N A
authors.initials: NA
authors.lastname: Ettinger
authors.forename: D
authors.initials: D
authors.lastname: Shevlin
authors.forename: M H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods* / Q000592:standards; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D012449:Safety; D012680:Sensitivity and Specificity