title: Yield and safety of bedside open lung biopsy in mechanically ventilated patients with acute lung injury or acute respiratory distress syndrome.
abstract: BACKGROUND
  The utility of open lung biopsy (OLB) in mechanically ventilated patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) of unknown origin has been questioned because of its potentially low diagnostic yield and possibly related morbidity. To quantify possible benefits and risks, and especially so for bedside lung biopsy, we reviewed retrospectively our 8-year, single unit experience with this procedure.
  
  
  METHODS
  Mechanically ventilated, critically ill patients with acute respiratory failure of unknown origin who underwent OLB were analyzed in a retrospective, single-center, cohort study in a medical intensive care unit in a university medical center.
  
  
  RESULTS
  Twenty-seven patients were analyzed (15 female, 12 male, of mean 48 years [standard deviation, 14]), 67% of whom were immunocompromised. All patients underwent bronchoscopy and bronchoalveolar lavage before OLB. PaO2/Fraction of inspired oxygen at the time of biopsy was 188 +/- 109 mm Hg. Biopsies were performed in the operating room on 9 patients and at bedside on 18. A specific diagnosis was obtained in 70% of biopsies. Biopsy results led to alteration in treatment in 81% of patients. Minor complications occurred in 52% of patients and major complications in 7%. The rate of complications did not appear to differ with the location of the procedure (bedside vs operating room). No deaths were attributed to the procedure.
  
  
  CONCLUSIONS
  Bedside OLB can be performed safely in selected, mechanically ventilated, critically ill patients with ALI or ARDS. Our results support the concept that lung biopsy often leads to management alterations in patients where a standardized diagnostic workup failed to yield a definitive diagnosis.
authors.affiliation: University Medical Center Hamburg-Eppendorf Hamburg, Germany. hbaumann@uke.uni-hamburg.de
authors.forename: Hans Joerg
authors.initials: HJ
authors.lastname: Baumann
authors.forename: Stefan
authors.initials: S
authors.lastname: Kluge
authors.forename: Lorenz
authors.initials: L
authors.lastname: Balke
authors.forename: Emre
authors.initials: E
authors.lastname: Yekebas
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: Michael
authors.initials: M
authors.lastname: Amthor
authors.forename: Georg
authors.initials: G
authors.lastname: Kreymann
authors.forename: Andreas
authors.initials: A
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D015505:Chest Tubes; D003422:Critical Care; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies