A contributive result of open-lung biopsy improves survival in acute respiratory distress syndrome patients.
OBJECTIVE
The impact of a contributive result of open-lung biopsy on the outcome of patients with acute respiratory distress syndrome (ARDS) has not been extensively investigated. The aim of this study was therefore to determine the rate of contributive open-lung biopsy and whether it improved the prognosis of ARDS patients.


METHODS
Prospective study conducted during an 8-yr period.


METHODS
A 14-bed medico-surgical intensive care unit and a 12-bed medical intensive care unit from the same hospital.


METHODS
One hundred open-lung biopsies were performed in 100 patients presenting ARDS.


METHODS
Open-lung biopsy was performed after > or = 5 days of evolution of ARDS when there was no improvement in the respiratory status despite negative microbiological samples cultures and potential indication for corticosteroid treatment.


RESULTS
Ten patients presented a mechanical complication following open-lung biopsy (two pneumothoraces and eight moderate air leaks). The unique independent factor associated with this complication was the minute ventilation when open-lung biopsy was performed (odds ratio, 1.20; 95% confidence interval, 1.03-1.41; p = .02). Fibrosis was noted in 53 patients but was associated with an infection in 29 of these 53 patients (55%). A contributive result of open-lung biopsy (defined as the addition of a new drug) was noted in 78 patients. Simplified Acute Physiology Score II was the only independent predictive factor of a contributive open-lung biopsy (odds ratio, 0.96; 95% confidence interval, 0.92-0.99; p = .04). Survival was higher in patients with a contributive open-lung biopsy (67%) than in patients in whom open-lung biopsy results did not modify the treatment (14%) (p < .001). The factors predicting survival were a contributive result of open-lung biopsy, female gender, and the Organ System Failures score the day of open-lung biopsy.


CONCLUSIONS
The present study shows that open-lung biopsy provided a contributive result in 78% of ARDS patients with a negative bronchoalveolar lavage. Survival of ARDS patients improved when open-lung biopsy was contributive.
Papazian
Laurent
L
Service de Réanimation Médicale, Hôpital Sainte-Marguerite, Université de la Méditerranée, Marseille, France.
Doddoli
Christophe
C
Chetaille
Bruno
B
Gernez
Yaël
Y
Thirion
Xavier
X
Roch
Antoine
A
Donati
Yannis
Y
Bonnety
Marilyne
M
Zandotti
Christine
C
Thomas
Pascal
P
D018806:APACHE; D000328:Adult; D000368:Aged; D001706:Biopsy; D001992:Bronchoalveolar Lavage Fluid; D003586:Cytomegalovirus Infections / Q000401:mortality / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018410:Pneumonia, Bacterial / Q000401:mortality / Q000473:pathology; D011024:Pneumonia, Viral / Q000401:mortality / Q000473:pathology; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011650:Pulmonary Alveoli / Q000473:pathology; D011658:Pulmonary Fibrosis / Q000401:mortality / Q000473:pathology; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality / Q000473:pathology*