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Benefit of open lung biopsy in patients with respiratory failure.

OBJECTIVE
To determine the benefit of open lung biopsy (OLB) in patients with respiratory failure in whom medical therapy is unsuccessful.


DESIGN
A retrospective case series.


SETTING
A tertiary care centre.


PATIENTS
Thirty-one patients (20 men, 11 women, mean age 55 years) without the human immunodeficiency virus or AIDS who were suffering from respiratory failure.


INTERVENTION
OLB through a limited anterior thoracotomy.


MAIN OUTCOME MEASURES
Diagnosis, change in therapy, timing of OLB, immune status, survival.


RESULTS
A specific diagnosis was made in 68% of patients, and nonspecific pulmonary fibrosis was found in 32%. Eighteen patients (59%) had a change in therapy: 11 had new therapy and 7 had medical therapy withdrawn because of irreversible disease. There was a significant (p = 0.012) improvement in survival in those who had OLB early compared with those who had OLB later in the course of the disease (70% versus 14%). There was a significant (p = 0.026) difference in the proportion of specific diagnoses made among those who had OLB early compared with those who had it later (100% versus 52%). A significant (p = 0.18) improvement in survival was noted in those who had new therapy instituted as a result of early OLB compared with late OLB (86% versus 25%). Patients not immunocompromised before OLB had a significantly (p = 0.02) better survival rate than those who were immunocompromised.


CONCLUSIONS
The duration of respiratory failure before OLB and the immune status were associated with improved survival in patients with respiratory failure and unsuccessful medical therapy. This was not directly attributable to changes in therapy after OLB. However, five survived as a direct result of therapy instituted after OLB and seven were spared needless therapy when irreversible disease was found. Overall survival may not be altered by OLB, but individual clinical benefit may be seen in nearly 40% of patients.