title: Open lung biopsy in children with respiratory failure.
abstract: OBJECTIVE
  To evaluate benefits and risks of open lung biopsy in children with respiratory failure.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  A 36-bed pediatric critical care unit in a tertiary care, university-based hospital.
  
  
  METHODS
  We studied 31 patients with respiratory failure who underwent 33 open lung biopsies.
  
  
  RESULTS
  The charts of all children in the critical care unit with respiratory failure who underwent an open lung biopsy over a 10-yr period (1989-98) were reviewed. Of 33 open lung biopsies performed, 76% (25 of 33) led to a relevant change in medical management. Complications were seen in 45% of patients, predominantly attributable to airleak (33%) without affecting respiratory function. An infectious agent was detected by open lung biopsy in ten patients; bronchoalveolar lavage performed before open lung biopsy failed to isolate the infection in eight of ten patients.
  
  
  CONCLUSIONS
  In children with undiagnosed or persisting respiratory failure, open lung biopsy is a useful diagnostic procedure that leads to significant changes in medical management and increases the diagnostic yield for infections. Despite the relatively high complication rate, open lung biopsy should be performed routinely in this group of patients.
authors.affiliation: Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Kornecki
authors.forename: S D
authors.initials: SD
authors.lastname: Shemie
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D018893:Bronchoalveolar Lavage; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000473:pathology*; D012189:Retrospective Studies