Safety and yield of transbronchial biopsy in mechanically ventilated patients


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Abstract

ObjectiveTo evaluate the safety and diagnostic yield of transbronchial biopsy performed in mechanically ventilated patients.DesignRetrospective, cohort analysis.SettingA university-affiliated teaching hospital.PatientsSeventy-one consecutive, mechanically ventilated patients requiring lung tissue examination.InterventionsTransbronchial lung biopsy.Measurements and Main ResultsWe evaluated complications associated with transbronchial biopsy, diagnostic yield of the procedure, and changes in patient management based on the results of the transbronchial lung biopsies. Eighty-three transbronchial lung biopsy procedures were performed in this patient cohort. Complications associated with these procedures included the following: ten (14.3%) pneumothoraces in patients without preexisting chest tubes; five (6.0%) episodes of bronchial hemorrhage of >30 mL; transient oxygen desaturation to <90% in seven (8.4%) patients; hypotension with a mean arterial pressure of <60 mm Hg in six (7.2%) patients; and three (3.6%) episodes of tachycardia, with a heart rate of >140 beats/min. No patient deaths, episodes of pneumonia, or sepsis could be attributed to the transbronchial lung biopsy procedures. Specific histologic diagnoses were made with 29 (34.9%) of the transbronchial biopsies, and patient management was changed as a direct result of the lung tissue examination in 34 (41.0%) instances. Pathologic correlation between the transbronchial biopsy specimens and lung tissue obtained by open-lung biopsy or post mortem examination occurred in 11 (84.6%) of 13 paired samples.ConclusionTransbronchial lung biopsy can be performed with an acceptable risk and reasonable diagnostic yield in certain types of mechanically ventilated patients, often obviating the need to perform open-lung biopsy. (Crit Care Med 1997; 25:440-446)

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