The utility of surgical lung biopsy in critically ill patients with diffuse pulmonary infiltrates: A retrospective review

Background There are conflicting reports regarding the role of surgical lung biopsy in patients who present to the Intensive Care Unit with unexplained respiratory failure and diffuse pulmonary infiltrates on imaging. Aim To describe the utility of surgical lung biopsy in patients presenting to the Intensive Care Unit with unexplained respiratory failure and diffuse pulmonary infiltrates. Methods A retrospective cohort study was performed. All patients admitted to the intensive care unit who underwent a surgical lung biopsy for the investigation of respiratory failure and unexplained pulmonary infiltrates between 1998 and 2012 were included. The primary outcome measures for this descriptive study were the biopsy histopathology, changes in patient management following biopsy and in-hospital mortality. Results 30 patients were included in the review. Biopsies in 22 patients (73%) demonstrated Diffuse Alveolar Damage (DAD), with 15 of these biopsies (50%) suggesting a specific underlying aetiology. In 73% of cases (n = 22), the biopsy finding was associated with a change in management, although this generally involved escalation of an existing therapy, rather than initiation of a new treatment. Biopsies were performed at a median 10 days after admission (Interquartile Range (IQR) 5–17 days) with the majority of patients being treated empirically prior to the biopsy with systemic steroids and broad-spectrum antimicrobials. Mortality was 50%. Conclusion In this series, DAD was the most frequent pathology. The biopsy result was associated with a change in management in the majority of subjects, most frequently an escalation of prior empiric therapy. Mortality was high.