Impact of open lung biopsy on refractory acute respiratory failure
Impact of open lung biopsy on refractory acute respiratory failure
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DOI：
10.1590/s1806-37132006000500008
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发表时间：
2006-10-01
影响因子：
2.7
通讯作者：
Knobel, Elias
中科院分区：
文献类型：
--
作者：
Barbas, Carmen Silvia Valente;Capelozzi, Vera Luiza;Knobel, Elias
目的：确定肺活检结果对弥漫性肺浸润和难治性急性呼吸衰竭危重患者治疗策略改变决策的影响，以及对其临床改善的影响。方法：本研究纳入了12例机械通气的急性呼吸衰竭患者，这些患者在对标准治疗没有临床反应后进行了开胸肺活检。结果：5例患者（40%）的急性呼吸衰竭最常见的单一原因是病毒感染。11例（91.6%）患者术前对呼吸衰竭原因的评估有修改，100%的病例有明确的诊断。无论治疗方案如何改变，死亡率均为50%。6例患者（50%）存活出院。所有出院患者在开放肺活检后至少存活了一年，12例患者的总生存率为50%。在医院死亡的患者，开肺活检后生存时间为14 + 10.8天。结论：我们得出结论，在标准治疗后没有临床改善的急性呼吸衰竭的治疗中，开放式肺活检是一个有用的工具，因为它可以导致特定的诊断，需要不同的治疗，这可能会降低这类患者的死亡率。
OBJECTIVE: To determine the impact that open lung biopsy findings have on decisions regarding changes in the treatment strategies employed for critically ill patients presenting diffuse pulmonary infiltrates and suffering from refractory acute respiratory failure, as well as on their clinical improvement.METHODS: This study involved 12 mechanically ventilated patients with acute respiratory failure who were subjected to open lung biopsy (by thoracotomy) after not presenting a clinical response to standard treatment.RESULTS: The single most common cause of the acute respiratory failure was viral infection, which was identified in 5 patients (40%). The pre-operative evaluation of the cause of respiratory failure was modified in 11 patients (91.6%), and a specific diagnosis was made in 100% of the cases. Regardless of changes in treatment regimen, the mortality rate was 50%. Six patients (50%) survived to be discharged from the hospital. All of the discharged patients survived for at least one year after the open lung biopsy, for an overall one-year survival rate of 50% among the 12 patients studied. For the patients who died in the hospital, the time of survival after open lung biopsy was 14 + 10.8 days.CONCLUSION: We conclude that open lung biopsy is a useful tool in the management of acute respiratory failure when there is no clinical improvement after standard treatment, since it can lead to a specific diagnosis that requires distinct treatment, which probably lowers the mortality rate among such patients.