Safety and yield of transbronchial biopsy in mechanically ventilated patients

Objective: To evaluate the safety and diagnostic yield of transbronchial biopsy performed in mechanically ventilated patients. Design: Retrospective, cohort analysis. Setting: A university-affiliated teaching hospital. Patients: Seventy-one consecutive, mechanically ventilated patients requiring lung tissue examination. Interventions: Transbronchial lung biopsy. Measurements and Main Results: We evaluated complications associated with transbronchial biopsy, diagnostic yield of the procedure, and changes in patient management based on the results of the transbronchial lung biopsies. Eighty-three transbronchial lung biopsy procedures were performed in this patient cohort. Complications associated with these procedures included the following: ten (14.3%) pneumothoraces in patients without preexisting chest tubes; five (6.0%) episodes of bronchial hemorrhage of >30 mL; transient oxygen desaturation to <90% in seven (8.4%) patients; hypotension with a mean arterial pressure of <60 mm Hg in six (7.2%) patients; and three (3.6%) episodes of tachycardia, with a heart rate of >140 beats/min. No patient deaths, episodes of pneumonia, or sepals could be attributed to the transbronchial lung biopsy procedures. Specific histologic diagnoses were made with 29 (34.9%) of the transbronchial biopsies, and patient management was changed as a direct result of the lung tissue examination in 34 (41.0%) instances. Pathologic correlation between the transbronchial biopsy specimens and lung tissue obtained by open-lung biopsy or post mortem examination occurred in 11 (84.6%) of 13 paired samples. Conclusion: Transbronchial lung biopsy can be performed with an acceptable risk and reasonable diagnostic yield in certain types of mechanically ventilated patients, often obviating the need to perform open-lung biopsy.