Usefulness of open lung biopsy in mechanically ventilated patients with undiagnosed diffuse pulmonary infiltrates: Influence of comorbidities and organ dysfunction
Usefulness of open lung biopsy in mechanically ventilated patients with undiagnosed diffuse pulmonary infiltrates: Influence of comorbidities and organ dysfunction
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DOI：
10.1186/cc6106
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发表时间：
2007-01-01
期刊：
影响因子：
15.1
通讯作者：
Kwon, O. Jung
中科院分区：
文献类型：
--
作者：
Lim, Seong Yong;Suh, Gee Young;Kwon, O. Jung
背景 本研究的目的是评估开放性肺活检（OLB）对于因不明原因的弥漫性肺部浸润而接受机械通气的患者的临床有效性。方法这是在一个有 10 个床位的医疗重症监护病房进行的 10 年回顾性研究。对 1994 年至 2004 年间因诊断不明肺部浸润而接受 OLB 的 36 名依赖呼吸机的患者的医疗记录进行回顾性分析。分析的数据包括人口统计数据、Charlson 年龄合并症评分、器官功能障碍数量、急性生理学和慢性健康评估 (APACHE) II、简化急性生理学评分 (SAPS) II、序贯器官衰竭评估 (SOFA) 评分、通气变量和放射学模式。还评估了诊断率、对后续治疗改变的影响以及 OLB 并发症。结果 31 名患者 (86%) 获得了具体的临床病理诊断。最常见的诊断是间质性肺炎（n = 17，其中8例为急性间质性肺炎）和病毒性肺炎（n = 4）。 64% 的患者进行了治疗调整。开始机械通气后不到 1 周接受 OLB 的患者存活率更高（63% 对比 11%；P = 0.018）。没有与手术相关的重大并发症。与生存独立相关的因素是 Charlson 年龄-合并症评分、器官功能障碍的数量以及 OLB 当天的 PaO2/FiO(2) 比值。结论 OLB 可以为许多患有未确诊肺部浸润的依赖呼吸机的患者提供特异性诊断。早期 OLB 似乎对伴有单纯性呼吸衰竭的危重患者有用。
Background The purpose of this study was to evaluate the clinical usefulness of open lung biopsy (OLB) in patients undergoing mechanical ventilation for diffuse pulmonary infiltrates of unknown etiology.Methods This was a 10-year retrospective study in a 10-bed medical intensive care unit. The medical records of 36 ventilator-dependent patients who underwent OLB for the diagnosis of unknown pulmonary infiltrates from 1994 to 2004 were reviewed retrospectively. Data analyzed included demographic data, Charlson age-comorbidity score, number of organ dysfunctions, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA) score, ventilation variables, and radiological patterns. Diagnostic yield, effect on subsequent treatment changes, and complications of OLB were also assessed.Results A specific clinico-pathologic diagnosis was obtained for 31 patients (86%). The most common diagnoses were interstitial pneumonia (n = 17, including 8 acute interstitial pneumonia) and viral pneumonia (n = 4). Therapeutic modifications were made in 64% of patients. Patients who received OLB less than 1 week after initiation of mechanical ventilation were more likely to survive (63% versus 11%; P = 0.018). There were no major complications associated with the procedure. Factors independently associated with survival were the Charlson age-comorbidity score, number of organ dysfunction and the PaO2/FiO(2) ratio on the day of the OLB.Conclusion OLB can provide a specific diagnosis in many ventilator-dependent patients with undiagnosed pulmonary infiltrate. Early OLB seems to be useful in critically ill patients with isolated respiratory failure.