title: Impact of open lung biopsy on refractory acute respiratory failure.
abstract: OBJECTIVE
  To determine the impact that open lung biopsy findings have on decisions regarding changes in the treatment strategies employed for critically ill patients presenting diffuse pulmonary infiltrates and suffering from refractory acute respiratory failure, as well as on their clinical improvement.
  
  
  METHODS
  This study involved 12 mechanically ventilated patients with acute respiratory failure who were subjected to open lung biopsy (by thoracotomy) after not presenting a clinical response to standard treatment.
  
  
  RESULTS
  The single most common cause of the acute respiratory failure was viral infection, which was identified in 5 patients (40%). The pre-operative evaluation of the cause of respiratory failure was modified in 11 patients (91.6%), and a specific diagnosis was made in 100% of the cases. Regardless of changes in treatment regimen, the mortality rate was 50%. Six patients (50%) survived to be discharged from the hospital. All of the discharged patients survived for at least one year after the open lung biopsy, for an overall one-year survival rate of 50% among the 12 patients studied. For the patients who died in the hospital, the time of survival after open lung biopsy was 14 + 10.8 days.
  
  
  CONCLUSIONS
  We conclude that open lung biopsy is a useful tool in the management of acute respiratory failure when there is no clinical improvement after standard treatment, since it can lead to a specific diagnosis that requires distinct treatment, which probably lowers the mortality rate among such patients.
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Carmen Silvia Valente
authors.initials: CS
authors.lastname: Barbas
authors.forename: Vera Luiza
authors.initials: VL
authors.lastname: Capelozzi
authors.forename: Cristiane
authors.initials: C
authors.lastname: Hoelz
authors.forename: Ricardo Borges
authors.initials: RB
authors.lastname: Magaldi
authors.forename: Rogério
authors.initials: R
authors.lastname: de Souza
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Sandeville
authors.forename: José Ribas Milanez
authors.initials: JR
authors.lastname: de Campos
authors.forename: Eduardo
authors.initials: E
authors.lastname: Werebe
authors.forename: Laerte O
authors.initials: LO
authors.lastname: Andrade Filho
authors.forename: Elias
authors.initials: E
authors.lastname: Knobel
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies