Utility of surgical lung biopsy in critically ill patients with diffuse pulmonary infiltrates: a retrospective review

Abstract

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.

Video-Assisted Thoracoscopic Lung Biopsy in Critically Ill Patients With Hematologic Malignancy and Acute Respiratory Distress Syndrome: A Case Series Report

“…In one study, the diagnostic yield of open lung biopsy in the context of patients with hematologic malignancy was reported at 62%. 8 Its effectiveness, defined as the ability to generate a change in therapy, has been very variable among studies with reports that go from 57% to 94% 3,8,12,13 ; the efficacy obtained in the study performed by Papazian et al indicated that none of the patients received steroids prior to the biopsy. 13 A recent meta-analysis that included 95 case series of open lung biopsy reported a change in therapy of 78%, being the most common alterations in the initiation or tailoring of therapy, while discontinuation was seen in 10%.…”

“…The rate of complications reported in the literature is around 30%, in which the most common complication is persistent pneumothorax and initiation or an increase in ventilatory support. 3,8,12 One study reported hemorrhagic shock that required reintervention in 2 out of 76 patients. 12 Furthermore, the meta-analysis by Wong and Walkey reported only one case of perioperative mortality from 512 patients analyzed.…”

“…When the etiology remains unclarified, the most common procedure is to initiate empiric therapy, and although patients tend to respond, there is a small fraction that do not. 2,3 This set of patients may benefit from a surgical lung biopsy, either open via thoracotomy or through video-assisted thoracoscopic surgery (VATS), to guide therapy when noninvasive diagnostic procedures have been performed and uncertainty persists. Although a recent meta-analysis performed with data of critically ill, mechanically ventilated patients showed that open lung biopsy yielded a wide range of diagnosis and that treatment was changed in 78% of subjects, 4 other studies have not been able to show a substantial benefit in this population.…”

“…Furthermore, the role of surgical lung biopsy has not been extensively studied in patients with hematologic malignancy and ARDS and so doubt exists about the risk-benefit relationship of such procedures. 3…”

Biopsia pulmonar por minitoracotomía. ¿Es necesario el drenaje pleural?

“…1 En todos ellos se obtuvo tejido pulmonar en cantidad NCT www.medigraphic.org.mx adecuada para el diagnóstico independiente de la localización dentro del tórax, lo que permitió el inicio de una terapéutica o una readecuación de cambios en el manejo de los pacientes, tal como ha sido reportado. [2][3][4][5][6][7] Ninguno de nuestros pacientes presentó criterios para ventilación mecánica ni intubación endotraqueal previa o posterior a la finalización del procedimiento. Sin embargo, la contribución de la biopsia pulmonar abierta en la mejoría de la sobrevivencia de pacientes con dificultad respiratoria aguda ha sido ampliamente reportada 8-10 y para obtener un beneficio máximo debe ser reservada en pacientes con pronóstico razonable y no en pacientes moribundos.…”