Open lung biopsy in early-stage acute respiratory distress syndrome.
BACKGROUND
Acute respiratory distress syndrome (ARDS) has heterogeneous etiologies, rapid progressive change and a high mortality rate. To improve the outcome of ARDS, accurate diagnosis is essential to the application of effective early treatment. The present study investigated the clinical effects and safety of open lung biopsy (OLB) in patients with early-stage ARDS of suspected non-infectious origin.


METHODS
We undertook a retrospective study of 41 patients with early-stage ARDS (defined as one week or less after intubation) who underwent OLB in two medical intensive care units of a tertiary care hospital from 1999 to 2005. Data analyzed included baseline characteristics, complication rate, pathological diagnoses, treatment alterations, and hospital survival.


RESULTS
The age of patients was 55 +/- 17 years (mean +/- SD). The average ratio of arterial partial pressure of oxygen (PaO2) to fraction of inspired oxygen (FiO2) was 116 +/- 43 mmHg (mean +/- SD) at biopsy. Seventeen patients (41%) were immunocompromised. Postoperative complications occurred in 20% of patients (8/41). All biopsies provided a pathological diagnosis with a diagnostic yield of 100%. Specific pathological diagnoses were made for 44% of patients (18/41). Biopsy findings led to an alteration of treatment modality in 73% of patients (30/41). The treatment alteration rate was higher in patients with nonspecific diagnoses than in patients with specific diagnoses (p = 0.0024). Overall mortality was 50% (21/41) and was not influenced by age, gender, pre-OLB oxygenation, complication rate, pathological results, and alteration of treatment. There was no surgery-related mortality. The survival rate for immunocompromised patients was better than that for immunocompetent patients (71% versus 33%; p = 0.0187) in this study.


CONCLUSIONS
Our retrospective study suggests that OLB was a useful and acceptably safe diagnostic procedure in some selected patients with early-stage ARDS.
Kao
Kuo-Chin
KC
Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsin Street, Kweishan, Taoyuan 333, Taiwan. kck0502@adm.cgmh.org.tw
Tsai
Ying-Huang
YH
Wu
Yao-Kuang
YK
Chen
Ning-Hung
NH
Hsieh
Meng-Jer
MJ
Huang
Shiu-Feng
SF
Huang
Chung-Chi
CC
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D005260:Female; D006801:Humans; D008168:Lung / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000276:immunology / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies