&lt;![CDATA[&lt;B&gt;Impact of open lung biopsy on refractory acute respiratory failure&lt;/B&gt;]]&gt;

Barbas, Carmen Sílvia Valente; Capelozzi, Vera Luíza; Hoelz, C; Magaldi, R; Souza, Rogério; Sandeville, Maria Laura; Campos, Jos� R. M.; Werebe, Eduardo de Campos; Filho, Laerte O. Andrade; Knobel, E

doi:10.1590/s1806-37132006001300008

Cited by 6 publications

(14 citation statements)

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“…Patient mortality (defined variably as hospital, intensive care unit, or 28-30 days after open lung biopsy) was 54%. Mortality rates stratified by histopathological diagnosis did not differ significantly by diagnosis (P = 0.15; Table 2, reported in eight studies) (4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Systematic Reviewmentioning

confidence: 95%

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Open Lung Biopsy among Critically Ill, Mechanically Ventilated Patients: A Meta-Analysis

Wong

Walkey

2015

Annals ATS

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Rationale: Open lung biopsy may be performed to guide therapy in mechanically ventilated patients with diagnostic uncertainty regarding etiology of pulmonary infiltrates. Current evidence for open lung biopsy in mechanically ventilated patients comes from single-center case series.Objectives: We performed a metaanalysis of case series to determine diagnoses, complications, and changes in therapy after lung biopsy in critically ill patients requiring mechanical ventilation. Methods:We searched Medline for case series of lung biopsies in critically ill patients requiring mechanical ventilation. We pooled results of individual case series using random effects metaanalysis models to obtain summary proportions. Measurements and Main Results:We identified 14 case series including a total of 512 mechanically ventilated patients with 530 histopathological diagnoses. The most common diagnoses were "fibrosis/pneumonitis" (n = 155, 25%; 95% confidence interval [CI], 14-37%) and infection (n = 113, 20%; 95% CI, 15-27%). Viruses were the most commonly identified infectious etiology identified on open lung biopsy, representing 50% of potential pathogens. Diffuse alveolar damage was present in a minority of specimens (n = 100, 16%; 95% CI, 8-25%). Therapeutic changes after lung biopsy occurred in 399 patients (78%; 95% CI, 64-81%). Procedure-related complications occurred in 29% of patients (95% CI, 25-33%), most commonly persistent air leak. Mortality among mechanically ventilated patients after diagnostic open lung biopsy was 54%.Conclusions: Among mechanically ventilated patients with respiratory failure of unclear etiology, lung biopsy yielded a wide range of diagnoses and was associated with a change in therapy in most patients.

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Section: Systematic Reviewmentioning

confidence: 95%

“…Therapy was discontinued in 10% (n = 39, 95% CI, 7-13%) of patients. Two studies (20 patients, 5%) did not report therapeutic changes (4,5).…”

Section: Systematic Reviewmentioning

confidence: 99%

Open Lung Biopsy among Critically Ill, Mechanically Ventilated Patients: A Meta-Analysis

Wong

Walkey

2015

Annals ATS

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“…Until now, no reports of OLB findings used to guide the treatment of patients with H1N1 pneumonitis have been published, although according to many authors OLB is safe and diagnostically useful in patients with ARF, enabling appropriate therapy. [9][10][11][12] The pathogenesis of ARF associated with swine-origin influenza virus (S-OIV) infection in humans is unknown. The influenza virus triggers pulmonary inflammation owing to an infiltration of inflammatory cells and an immune response.…”

Section: Introductionmentioning

confidence: 99%

Pathological and ultrastructural analysis of surgical lung biopsies in patients with swine-origin influenza type A/H1N1 and acute respiratory failure

Capelozzi

Parra

Ximenes

et al. 2010

Clinics

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BACKGROUND:Cases of H1N1 and other pulmonary infections evolve to acute respiratory failure and death when co‐infections or lung injury predominate over the immune response, thus requiring early diagnosis to improve treatment.OBJECTIVE:To perform a detailed histopathological analysis of the open lung biopsy specimens from five patients with ARDS with confirmed H1N1.METHODS:Lung specimens underwent microbiologic analysis, and examination by optical and electron microscopy. Immunophenotyping was used to characterize macrophages, natural killer, T and B cells, and expression of cytokines and iNOS.RESULTS:The pathological features observed were necrotizing bronchiolitis, diffuse alveolar damage, alveolar hemorrhage and abnormal immune response. Ultrastructural analysis showed viral‐like particles in all cases.CONCLUSIONS:Viral‐like particles can be successfully demonstrated in lung tissue by ultrastructural examination, without confirmation of the virus by RT‐PCR on nasopharyngeal aspirates. Bronchioles and epithelium, rather than endothelium, are probably the primary target of infection, and diffuse alveolar damage the consequence of the effect of airways obliteration and dysfunction on innate immunity, suggesting that treatment should be focused on epithelial repair.

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“…The diagnostic yield of OLB, which does not specifically address solid organ transplant patients, ranges between 34% and 100% (16,17,19,(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). In solid organ transplant patients, Defranchi et al reported that 29% had a change in clinical management as a result of the OLB findings (16).…”

Section: Discussionmentioning

confidence: 99%

The diagnostic yield and complications of open lung biopsies in kidney transplant patients with pulmonary disease

et al. 2017

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Background: The purpose of this study was to assess the efficacy of open lung biopsy (OLB) in determining the specific diagnosis and the related complications in patients with undiagnosed diffuse pulmonary infiltrates.Methods: This single center, retrospective study included adult kidney transplant patients who underwent OLB. The patients had diffuse pulmonary infiltrates without definitive diagnoses and failed to respond to empiric antibiotic treatment. We analyzed the number of specific diagnoses, changes in treatment and the occurrence of complications in these patients. A logistic regression was used to determine which variables were predictors of hospital mortality. Results: From April 2010 to April 2014, 87 patients consecutively underwent OLB. A specific diagnosis was reached in 74 (85.1%) patients. In 46 patients (53%), their therapeutic management was changed after the OLB results. Twenty-five (28.7%) patients had complications related to the OLB. The hospital mortality rate was 25.2%. Age, SAPS3 score and complications related to the procedure were independent predictors of all-cause mortality. Conclusions: OLB is a high-risk procedure with a high diagnostic yield in kidney transplant patients with diffuse pulmonary infiltrates who did not have a definitive diagnosis and who failed to respond to empiric antibiotic treatment. Complications related to OLB were common and were independently associated with intra-hospital mortality.

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<![CDATA[<B>Impact of open lung biopsy on refractory acute respiratory failure</B>]]>

Cited by 6 publications

References 0 publications

Open Lung Biopsy among Critically Ill, Mechanically Ventilated Patients: A Meta-Analysis

Open Lung Biopsy among Critically Ill, Mechanically Ventilated Patients: A Meta-Analysis

Pathological and ultrastructural analysis of surgical lung biopsies in patients with swine-origin influenza type A/H1N1 and acute respiratory failure

The diagnostic yield and complications of open lung biopsies in kidney transplant patients with pulmonary disease

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