Morbidity and Mortality of Open Lung Biopsy in Children

Abstract

The morbidity and mortality rates of children with ARF undergoing OLB for diffuse pulmonary infiltrates differ considerably from those of children without ARF. For children with ARF, OLB is associated with the risk of prolonged ventilatory support, recurrent pneumothoraces, and air leaks. These complications may be attributable to such patients' having diseased lungs with poor healing. Moreover, these complications may, in turn, contribute to the patients' poor outcomes.

An Official American Thoracic Society Clinical Practice Guideline: Classification, Evaluation, and Management of Childhood Interstitial Lung Disease in Infancy

“…OLB has been the primary surgical approach in young children (120,121,132,133). However, VATS visualizes a greater percentage of the lung and permits the sampling of different lobes with the same incision sites (a consensus statement recommends multiple biopsy sites [134], even though there are limited data to support this approach [58]).…”

Do Immunocompromised Children Benefit from Having Surgical Lung Biopsy Performed?

“…Studies on SLB in children are scarce, all are retrospective, and they describe small cohorts which are mostly heterogeneous [5,11,12,13,14,15,16,17,18,19,20,21,22]. This makes drawing conclusions about the role of this procedure in the management of immunocompromised patients presenting with pulmonary findings a difficult task.…”

“…In many of the publications, the study population is heterogeneous and consists of primary immune deficiencies, SCT and patients on different chemotherapy regimens. The severity of the clinical condition of patients in these studies also varies considerably; the proportion of patients who were ventilated with or without multiorgan failure in critical-care units, when the SLB was performed, ranged from 2 to 100% [12,13,14,15,16,17,18,19,23]. Our study demonstrated a lower yield of SLB in comparison to the results presented by others, with the estimation of the yield of SLB ranging from 33 to 69% across studies [5,13,14,15,16,17,18,19].…”

“…However, in some studies, a diagnosis based on SLB specimens has been reported to be less accurate when the patients are immunocompromised children [11,12,13,14,15,16]. This contrasts with a recent report in which 94% of the biopsies yielded a diagnosis [17].…”

“…Also, when taking into account the complication rates in children after SLB, which varies widely, i.e. from 5 to 51% [5,11,12,13,15,16,17,18,19], the role of SLB as part of the management of immunocompromised patients is a matter of debate. The aim of our study was to assess the benefit of SLB in immunocompromised pediatric patients and to evaluate the impactof preoperative factors on their outcome.…”