Brief Clinical Report
Yield and safety of bedside open lung
biopsy in mechanically ventilated
patients with acute lung injury or
acute respiratory distress syndrome
Hans Joerg Baumann, MD,
Stefan Kluge, MD,
Lorenz Balke, MD,
Emre Yekebas, MD,
Jakob R. Izbicki, MD,
Michael Amthor, MD,
Georg Kreymann, MD,
and Andreas Meyer, MD,
Hamburg and Rotenburg/Wümme, Germany
Background. The utility of open lung biopsy (OLB) in mechanically ventilated patients with acute
lung injury (ALI) or acute respiratory distress syndrome (ARDS) of unknown origin has been
questioned because of its potentially low diagnostic yield and possibly related morbidity. To quantify
possible beneﬁts and risks, and especially so for bedside lung biopsy, we reviewed retrospectively our
8-year, single unit experience with this procedure.
Methods. Mechanically ventilated, critically ill patients with acute respiratory failure of unknown
origin who underwent OLB were analyzed in a retrospective, single-center, cohort study in a medical
intensive care unit in a university medical center.
Measurements and Main Results. Twenty-seven patients were analyzed (15 female, 12 male, of mean
48 years [standard deviation, 14]), 67% of whom were immunocompromised. All patients underwent
bronchoscopy and bronchoalveolar lavage before OLB. Pa
/Fraction of inspired oxygen at the time of
biopsy was 188 Ϯ 109 mm Hg. Biopsies were performed in the operating room on 9 patients and at
bedside on 18. A speciﬁc diagnosis was obtained in 70% of biopsies. Biopsy results led to alteration in
treatment in 81% of patients. Minor complications occurred in 52% of patients and major
complications in 7%. The rate of complications did not appear to differ with the location of the
procedure (bedside vs operating room). No deaths were attributed to the procedure.
Conclusions. Bedside OLB can be performed safely in selected, mechanically ventilated, critically ill
patients with ALI or ARDS. Our results support the concept that lung biopsy often leads to
management alterations in patients where a standardized diagnostic workup failed to yield a deﬁnitive
diagnosis. (Surgery 2008;143:426-433.)
From University Medical Center Hamburg-Eppendorf Hamburg,
and the Diakoniekrankenhaus
The scenario of acute lung injury (ALI) or
acute respiratory distress syndrome (ARDS) of
unknown origin presents a diagnostic and thera-
peutic challenge, especially in immunocompromised
patients. Accurate diagnosis of the underlying pathol-
ogy is essential to choosing the appropriate treatment
and avoiding unnecessary and possibly harmful op-
tions. In most patients, a diagnosis can be obtained
from history, laboratory, radiologic diagnostics, and
less invasive procedures such as bronchoscopy, in-
cluding bronchoalveolar lavage (BAL).
In a sub-
group of patients, these measures are not diagnostic.
The magnitude of this latter group depends on the
population studied. In less critically ill patients, con-
servative management with empiric treatment seems
appropriate despite the risk of potentially unneces-
The ﬁrst two authors contributed equally to this work.
Accepted for publication June 5, 2007.
Reprint requests: Dr. Hans Joerg Baumann, MD, Pulmonary
and Critical Care Specialist, University Medical Center Ham-
burg-Eppendorf, II. Department of Internal Medicine,
Martinistrasse 52, Hamburg, 20246, Germany. E-mail:
0039-6060/$ - see front matter
© 2008 Mosby, Inc. All rights reserved.