title: Utility of surgical lung biopsy in critically ill patients with diffuse pulmonary infiltrates: a retrospective review.
abstract: BACKGROUND
  There are conflicting reports regarding the role of surgical lung biopsies in patients who present to the intensive care unit (ICU) with unexplained respiratory failure and diffuse pulmonary infiltrates on imaging.
  
  
  OBJECTIVE
  To describe the utility of surgical lung biopsies in patients presenting to the ICU with unexplained respiratory failure and diffuse pulmonary infiltrates.
  
  
  METHODS
  A retrospective cohort study was performed. All patients admitted to the ICU who underwent a surgical lung biopsy for the investigation of respiratory failure and unexplained pulmonary infiltrates between 1998 and 2012 were included. The primary outcome measures for this descriptive study were the biopsy histopathology, changes in patient management following biopsy and in-hospital mortality.
  
  
  RESULTS
  A total of 30 patients was included in the review. Biopsies in 22 patients (73%) demonstrated diffuse alveolar damage (DAD), with 15 of these biopsies (50%) suggesting a specific underlying aetiology. In 73% of cases (n = 22), the biopsy finding was associated with a change in management, although this generally involved the escalation of an existing therapy rather than initiation of a new treatment. Biopsies were performed at a median 10 days after admission (interquartile range 5-17 days), with the majority of patients being treated empirically prior to the biopsy with systemic steroids and broad-spectrum antimicrobials. Mortality was 53%.
  
  
  CONCLUSIONS
  In this series, DAD was the most frequent pathology. The biopsy result was associated with a change in management in a majority of the subjects, most frequently an escalation of prior empiric therapy. Mortality was high.
authors.affiliation: Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia. lachlandonaldson@gmail.com.
authors.forename: L H
authors.initials: LH
authors.lastname: Donaldson
authors.affiliation: Department of Surgical Pathology, University of Sydney, Sydney, New South Wales, Australia.|Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Gill
authors.affiliation: Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Hibbert
mesh_terms: D000368:Aged; D001315:Australia; D001706:Biopsy; D016638:Critical Illness / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008168:Lung / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000473:pathology; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D020775:Thoracic Surgery, Video-Assisted
keywords: adult respiratory distress syndrome; biopsy; intensive care unit; pulmonary surgical procedure; respiratory insufficiency