Evaluation of Open Lung Biopsy in Critically Ill, Ventilator Dependent Intensive Care Unit Patients

OBJECTIVE: Evaluation of the benefits and risks of performing open lung biopsy (OLB) in critically ill, ventilator dependent intensive care unit patients.DESIGN: Retrospective chart review from 1990 to 1995.SETTING: A tertiary care teaching hospital intensive care unit.INTERVENTION: OLB in patients requiring mechanical ventilation for respiratory failure.MEASUREMENTS: Data collected included preoperative investigations, lung injury score, diagnosis, treatment and eventual outcome.RESULTS: Twenty-seven patients (14 male, 13 female) were mechanically ventilated before OLB for a median duration of seven days. A change in clinical management occurred in 85% of the patients as a result of new information obtained from the OLB. There was no statistical difference in overall outcome whether OLB was performed early or later in the course of respiratory failure once the patient was mechanically ventilated. The incidence of perioperative complications was 37%. Ten patients eventually left hospital.CONCLUSIONS: In a small percentage of intensive care patients refractory to the usual medical treatment modalities, open lung biopsy intervention is required to attempt to obtain a specific diagnosis.

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ROLE OF THE OPEN LUNG BIOPSY IN THE EVALUATION OF UNDIAGNOSED ACUTE LUNG DISEASE IN A PEDIATRIC INTENSIVE CARE UNIT

Critical Care Medicine ◽

10.1097/00003246-199901001-00053 ◽

1999 ◽

Vol 27 (Supplement) ◽

pp. 42A

Author(s):

Albert Bousso ◽

Evandro R. Baldacci ◽

Jose P. Otoch ◽

Bernardo Ejzenberg ◽

Yassuhiko Okay

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Lung Disease ◽

Pediatric Intensive Care Unit ◽

Lung Biopsy ◽

Pediatric Intensive Care ◽

Open Lung Biopsy ◽

Open Lung

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ROLE OF OPEN LUNG BIOPSY IN THE INTENSIVE CARE UNIT

Critical Care Medicine ◽

10.1097/00003246-199501001-00193 ◽

1995 ◽

Vol 23 (Supplement) ◽

pp. A120

Author(s):

Paul A. Lange ◽

Mohammed K. Dardari ◽

Thomas W. Rice ◽

Charles J. Fisher

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Lung Biopsy ◽

Open Lung Biopsy ◽

Open Lung

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Open Lung Biopsy among Critically Ill, Mechanically Ventilated Patients: A Meta-Analysis

Annals of the American Thoracic Society ◽

10.1513/annalsats.201502-077bc ◽

2015 ◽

pp. 150611181037005 ◽

Cited By ~ 4

Author(s):

Alexandra K Wong ◽

Allan J Walkey

Keyword(s):

Critically Ill ◽

Lung Biopsy ◽

Meta Analysis ◽

Open Lung Biopsy ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Open Lung ◽

Ventilated Patients

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Risks and Benefits of Open Lung Biopsy in the Mechanically Ventilated, Critically Ill Populatio

CHEST Journal ◽

10.1378/chest.124.4_meetingabstracts.206s-a ◽

2003 ◽

Vol 124 (4) ◽

pp. 206S

Author(s):

Raees Ahmed ◽

Yaseen Arabi ◽

Qanta A. Ahmed ◽

Masood U. Rehman ◽

Abdullah Al Shimemeri ◽

...

Keyword(s):

Critically Ill ◽

Lung Biopsy ◽

Open Lung Biopsy ◽

Mechanically Ventilated ◽

Open Lung ◽

Risks And Benefits

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Diagnostic Open Lung Biopsy in the Critically Ill Child

PEDIATRICS ◽

10.1542/peds.52.4.605 ◽

1973 ◽

Vol 52 (4) ◽

pp. 605-608

Author(s):

Stacy A. Roback ◽

William H. Weintraub ◽

Mark Nesbit ◽

Panayiotis K. Spanos ◽

Barbara Burke ◽

...

Keyword(s):

Pulmonary Function ◽

Critically Ill ◽

Lung Tissue ◽

Lung Biopsy ◽

Open Lung Biopsy ◽

University Of Minnesota ◽

Biopsy Technique ◽

Open Lung ◽

Critically Ill Child ◽

The University

Forty-six open biopsies in 40 acutely ill children with rapidly decreasing pulmonary reserve were performed at the University of Minnesota Hospitals between January 1, 1970, and January 1, 1972. Tissue obtained was adequate in all patients and no serious complications ensued. Information obtained resulted in the change in treatment in 30 patients. This procedure is recommended over closed biopsy when the magnitude of the patient's illness and degree of pulmonary function do not allow acceptance of the risks known to occur with a closed biopsy technique and when histologic examination of lung tissue is required.

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The ethical concerns of seeking consent from critically ill, mechanically ventilated patients for research – A matter of possessing capacity or surrogate insight

Clinical Ethics ◽

10.1177/1477750918762350 ◽

2018 ◽

Vol 13 (3) ◽

pp. 107-111 ◽

Cited By ~ 2

Author(s):

Avelino C Verceles ◽

Waqas Bhatti

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Informed Consent ◽

Critically Ill ◽

Ethical Issues ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ethical Concerns ◽

Multiple Factors ◽

Ventilated Patients

Conducting clinical research on subjects admitted to intensive care units is challenging, as they frequently lack the capacity to provide informed consent due to multiple factors including intensive care unit acquired delirium, coma, the need for sedation, or underlying critical illness. However, the presence of one or more of these characteristics does not automatically designate a potential subject as lacking capacity to provide their own informed consent. We review the ethical issues involved in obtaining informed consent for medical research from mechanically ventilated, critically ill patients, in addition to the concerns that may arise when a legally authorized representative is asked to provide informed consent on behalf of these patients.

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Measuring energy expenditure in the intensive care unit: a comparison of indirect calorimetry by E-sCOVX and Quark RMR with Deltatrac II in mechanically ventilated critically ill patients

Critical Care ◽

10.1186/s13054-016-1232-6 ◽

2016 ◽

Vol 20 (1) ◽

Cited By ~ 18

Author(s):

Martin Sundström Rehal ◽

Erik Fiskaare ◽

Inga Tjäder ◽

Åke Norberg ◽

Olav Rooyackers ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Energy Expenditure ◽

Critically Ill ◽

Indirect Calorimetry ◽

Critically Ill Patients ◽

Mechanically Ventilated

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Interrelated factors of tracheostomy in critically ill pediatric patients during their stay at ICU or PICU in Japan: a data-based analysis

10.21203/rs.2.20796/v1 ◽

2020 ◽

Author(s):

Tadashi Ishihara ◽

Hiroshi Tanaka

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Critically Ill ◽

Chronic Conditions ◽

Large Scale ◽

Pediatric Patients ◽

Upper Airway ◽

Chromosomal Anomalies ◽

Multicenter Cohort Study

Abstract Background The most common current indications of pediatric tracheostomy include prolonged ventilator dependence, often resulting from the consequences of prematurity and bronchopulmonary dysfunction, and upper airway obstruction resulting either from craniofacial or structural abnormalities of the upper airway or from hypotonia stemming from neurological or neuromuscular disturbance. The purpose of this study was to describe the indications, epidemiology, frequency, and associated factors for tracheostomy in critical pediatric patients admitted to the intensive care unit (ICU) or pediatric intensive care unit (PICU) by using the large amount of data available in the Japanese Registry of Pediatric Acute Care (JaRPAC). Methods In this retrospective multicenter cohort study, we collected data concerning pediatric tracheostomy from the JaRPAC database involving patients aged ≤ 16 years who had no tracheostomy when admitted to ICU or PICU between April 2014 and March 2017. The patients were divided into two groups: those with tracheostomies when they were discharged from the ICU or PICU and patients without tracheostomies. Interrelated factors of tracheostomy were investigated. Results A total of 23 hospitals participated, involving 6,199 pediatric patients registered in the JaRPAC database during the study period. Of the registered pediatric patients, 5,769 (95%) patients were admitted to the ICU or PICU without tracheostomies. Among the patients, 181 patients (3.1%) had undergone tracheostomies. There were significant differences in the number of chronic conditions (134, 74.0% versus 3096, 55.4%, p < 0.01), chromosomal anomalies (19, 10.5% versus 326, 5.8%, p < 0.01), urgent admission (151, 83.4% versus 3093, 55.4%, p < 0.01). More tracheostomies were performed on patients who were admitted for respiratory failure (61, 33.7% versus 926, 16.1%, p < 0.01) and for post-CPA resuscitation (40, 22.1% versus 71, 1.1%, p < 0.01). Conclusions This is the first report to use a large-scale registry of critically ill pediatric patients in Japan to describe the interrelated factors of tracheostomies during their stay in ICUs or PICUs. Chronic conditions (especially for neuromuscular disease), chromosomal anomaly, urgent admission, admission due to respiratory failure, or treatment for post-CPA resuscitation all had the possibility to be risk factors for tracheostomy.

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