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

Abstract

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.

Diagnostic Yield, Safety and Impact of Transbronchial Lung Biopsy in Mechanically Ventilated Critically Ill Patients: A Retrospective Study

“…Complication rate of the TBLB was low (11.9%) in the present study, although there was one serious adverse event with ultimately fatal outcome. In contrast, complications after SLB in mechanically ventilated patients occur in about 29%, which are mainly attributable to a high number of persistent air-leaks [2]. Pneumothorax incidence (12.5%) was comparable to previous studies [6][7] although one pneumothorax was related to transbronchial cryobiopsy, and there was no case of persistent air-leak.…”

“…In contrast, the histopathological result of a lung biopsy may provide important information on the underlying disease and could have signi cant impact on treatment decisions. Surgical lung biopsy (SLB) is the commonly used technique in such patients [2][3], but hypoxemia may worsen dramatically with single-lung ventilation, and the procedure usually requires a transfer from the intensive care unit (ICU) to the operating theater. Alternatively, bronchoscopic, transbronchial lung biopsy (TBLB, by means of forceps biopsy or cryobiopsy) is available, which also can be performed at the bedside in the ICU in the event of mechanical ventilation [4][5][6][7][8][9].…”

Transbronchial Lung Cryobiopsy May be of Value for Nonresolving Acute Respiratory Distress Syndrome: Case series and Systematic literature Review

“…Moreover, 37% (19/51) of the patients had a steroid-sensitive pathologic disease pattern (OP, acute interstitial pneumonia, acute exacerbation of usual interstitial pneumonia, eosinophilic pneumonia, pneumocystis pneumonia, alveolar hemorrhage and amiodarone toxicity); these patients had significantly better outcomes than patients with steroid-resistant pathologies (in-hospital mortality rate: 37% vs. 65%; 180-day mortality rate: 37% vs. 75%). In our study based on the combined data of reported cases, the summary diagnostic yield of TBLC was 92%, and 56% of patients had a diagnosis other than DAD, which led to management changes in 80% of patients (similar to SLB) (19). These results indicate that TBLC may be an alternative biopsy method to SLB for patients with nonresolving ARDS.…”

“…One of the most important advantages of this novel technique over SLB is the superior safety profile. The overall complication rate of SLB is about 30%, most of which (71%) are persistent air leaks (19); this rate of complications is significantly higher than that for TBLC (8%).…”

Quantitative analysis and clonal characterization of T-cell receptor β repertoires in patients with advanced non-small cell lung cancer treated with cancer vaccine

“…However, these assays require the ex vivo expansion of peripheral blood lymphocytes (PBLs) via stimulation and are not practical in clinical settings (25). In addition, lung tumor biopsy to examine intratumoral CTL infiltration is invasive (26). Therefore, it may be preferable to identify biomarkers from easily available human materials, including blood, using the predictive power that has been demonstrated to associate well with overall survival (OS) rate (27).…”