Indications

Complicated Parapneumonic Effusion/Empyema with Incomplete Drainage by Chest Tube (see Pleural Effusion-Parapneumonic)

• xxx

Lung Cancer with Requirement for Lung Resection (Lung Cancer)

• Types
  • Lobectomy

Open Lung Biopsy for Diagnosis of Interstitial Lung Disease (see Interstitial Lung Disease)

• xxx

Diagnosis of Etiology of Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome)

Clinical Efficacy

• Open Lung Biopsy Can Be Performed Safely in Select Patients with ARDS and Often Reveals an Unsuspected Diagnosis, Leading to an Alteration in Therapy (Chest, 2004) [MEDLINE]: unsuspected diagnoses in the study included infection (n = 8), alveolar hemorrhage (n = 5), and bronchiolitis obliterans organizing pneumonia (n = 5)
• Diffuse Alveolar Damage is Present in Most Patients with Unresolving ARDS and its Frequency is the Same Regardless of the Stage of ARDS (Mild, Moderate, Severe) (Intensive Care Med, 2015) [MEDLINE]: authors concluded that steroid therapy is not recommended
• Meta-Analysis of Utility of Open Lung Biopsy in ARDS Demonstrated that Biopsy Revleaed a Wide Range of Diagnoses and was Associated with a Change in Therapy in 78% of Cases(Ann Am Thorac Soc, 2015) [MEDLINE]
  • The Most Common Diagnoses were “Fibrosis/Pneumonitis” (n = 155, 25%; 95% CI: 14-37%) and Infection (n = 113, 20%; 95% CI: 15-27%): viruses were the most common infectious agents (accounted for 50% of infectious cases)
  • Diffuse Alveolar Damage was Present in Only 16% of Specimens
  • Procedure-Related Complications Occurred in 29% of Patients: most commonly persistent air leak

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Technique

Procedures Performed During Video-Assisted Thoracoscopic Surgery (VATS)

• Pleural Drainage
• Decortication (see Decortication)
• Open Lung Biopsy (see Open Lung Biopsy)
• Lung Resection (see Lung Resection)

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Adverse Effects/Complications

• xxxx

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References

Indications

• Diagnosis of nosocomial bacterial pneumonia in acute, diffuse lung injury. Chest. 1981;80(3):254 [MEDLINE]
• Open-lung biopsy in patients with acute respiratory distress syndrome. Anesthesiology. 1998;88(4):935 [MEDLINE]
• Combined bronchoalveolar lavage and transbronchial lung biopsy: safety and yield in ventilated patients. Eur Respir J. 2003;21(3):489 [MEDLINE]
• The role of open-lung biopsy in ARDS. Chest. 2004;125(1):197 [MEDLINE]
• Yield and safety of bedside open lung biopsy in mechanically ventilated patients with acute lung injury or acute respiratory distress syndrome. Surgery. 2008 Mar;143(3):426-33 [MEDLINE]
• Open lung biopsy in nonresolving ARDS frequently identifies diffuse alveolar damage regardless of the severity stage and may have implications for patient management. Intensive Care Med. 2015 Feb;41(2):222-30 [MEDLINE]
• Open Lung Biopsy Among Critically Ill, Mechanically Ventilated Patients. A Metaanalysis. Ann Am Thorac Soc. 2015;12(8):1226 [MEDLINE]
• The Role of Open Lung Biopsy in Critically Ill Patients with Hypoxic Respiratory Failure: A Retrospective Cohort Study. Can Respir J. 2016;2016:8715024 [MEDLINE]
• Utility of surgical lung biopsy in critically ill patients with diffuse pulmonary infiltrates: a retrospective review. Intern Med J. 2016;46(11):1306 [MEDLINE]