Safety and yield of transbronchial biopsy in mechanically ventilated patients

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Abstract
Objective To evaluate the safety and diagnostic yield of transbronchial biopsy performed in mechanically ventilated patients. Design Retrospective, cohort analysis. Setting A university-affiliated teaching hospital. Patients Seventy-one consecutive, mechanically ventilated patients requiring lung tissue examination. Interventions Transbronchial lung biopsy. Measurements and Main Results We 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 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. Conclusion Transbronchial 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)