Open Lung Biopsy (OLB) in patients (PTS) with diffuse pulmonary infiltrates and acute respiratory failure

PURPOSE: The adult respiratory distress syndrome remains a common cause of acute respiratory failure. Often the clinical data do not define the etiology. METHODS: We examined the role of OLB in 80 (42 males, 38 females) pts. with acute diffuse pulmonary infiltrates who failed to respond to empirical treatment or in whom no identifiable etiology was obtained with conventional diagnostic procedures including bronchoscopy. All pts. had an acute pulmonary process of less than 30 days duration, bilateral diffuse infiltrates at time of OLB, and did not have chronic lung disease. 62 pts. were immunocompetent, 18 were immunocompromised. All were on mechanical ventilation before OLB which was performed between 1 and 50 days (mean 13.2 ± 10d) from onset of symptoms. RESULTS: A specific etiology was obtained in 37 pts. (46%); BOOP in 10; PCP in 7; bacterial pneumonia in 5; lupus pneumonias in 3; drug induced toxicity in 2; pulmonary emboli in 1; toxoplasmosis in 1; coccidiomycosis in 2; adenoca in 1; pulmonary edema in 1; miliary TB in 1. 40 pts (50%) had acute alveolar injury without a specific etiology. We also examined the benefit of OLB in terms of finding an etiological diagnosis which is treatable. This was found in 28 pts (35%). Mortality in this group (54%) was not statistically different from those where a specific etiology was not found (60%). CONCLUSION AND CLINICAL IMPLICATIONS: We conclude that in patients with acute infiltrative lung disease and respiratory failure, OLB can detect a potentially treatable etiology, however, in our group of pts. this finding did not improve survival.