title: A contributive result of open-lung biopsy improves survival in acute respiratory distress syndrome patients.
abstract: 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.
authors.affiliation: Service de Réanimation Médicale, Hôpital Sainte-Marguerite, Université de la Méditerranée, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
authors.forename: Christophe
authors.initials: C
authors.lastname: Doddoli
authors.forename: Bruno
authors.initials: B
authors.lastname: Chetaille
authors.forename: Yaël
authors.initials: Y
authors.lastname: Gernez
authors.forename: Xavier
authors.initials: X
authors.lastname: Thirion
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.forename: Yannis
authors.initials: Y
authors.lastname: Donati
authors.forename: Marilyne
authors.initials: M
authors.lastname: Bonnety
authors.forename: Christine
authors.initials: C
authors.lastname: Zandotti
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
mesh_terms: 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*