Open lung biopsy in patients on mechanical ventilation with suspected diffuse lung disease
Biópsia pulmonar cirúrgica em doentes sob ventilação invasiva e com suspeita de doença difusa do parênquima pulmonar
Natália Melo1,
, Sandra Figueiredo1, António Morais2, Conceição Souto Moura3, Paulo Pinho4, Pedro Bastos5, Teresa Oliveira6
Corresponding author
nataliafmelo@hotmail.com
Correspondence to/Correspondência: Serviço de Pneumologia, Hospital de S. João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Telefone: 919371855.
Correspondence to/Correspondência: Serviço de Pneumologia, Hospital de S. João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Telefone: 919371855.
1 Interna Complementar de Pneumologia/Resident, Pulmonology
2 Assistente Hospitalar de Pneumologia/Consultant Pulmonology Serviço de Pneumologia do H.S.João – Director de Serviço: Prof. Dr. Venceslau Hespanhol/Pulmonology Unit, H. S. João, Porto – Unit Director: Prof. Dr. Venceslau Hespanhol
3 Assistente Hospitalar Graduada de Anatomia Patológica – Serviço de Anatomia Patológica do H. S. João – Directora de Serviço: Prof. Dra. Fátima Carneiro/Consultant, Specialist, Anatomical Pathology – Anatomical Pathology Unit, H. S. João – Unit Director: Prof. Dr. Fátima Carneiro
4 Director de Serviço – Serviço de Cirurgia Cardiotorácica do Hospital de S. João/Unit Director, Cardiothoracic Surgery Unit, Hospital de S. João
5 Chefe de Serviço de Cirurgia Cardiotorácica – Serviço de Cirurgia Cardiotorácica do Hospital de S. João – Director de Serviço: Dr. Paulo Pinho/Unit Head, Cardiothoracic Surgery Unit, Hospital de S. João – Unit Director: Dr. Paulo Pinho
6 Assistente Hospitalar Graduada em Anestesiologia – Serviço de Cuidados Intensivos – Director de Serviço: Dra. Ana Maria Mota/Consultant, Specialist, Anesthesiology – Intensive Care Unit – Unit Director: Dr. Ana Maria Mota
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João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Telefone: 919371855." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Biópsia pulmonar cirúrgica em doentes sob ventilação invasiva e com suspeita de doença difusa do parênquima pulmonar" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-11-21" "fechaAceptado" => "2009-02-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec160185" "palabras" => array:3 [ 0 => "Open lung biopsy" 1 => "mechanical ventilation" 2 => "diffuse lung infiltrates" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec160186" "palabras" => array:3 [ 0 => "Biópsia pulmonar cirúrgica" 1 => "ventilação invasiva" 2 => "infiltrados pulmonares difusos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">While open lung biopsy (OLB) performed in patients on mechanical ventilation (MV) with diffuse lung diseases (DLD) can be extremely important in establishing the diagnosis, the associated risk of this procedure should be taken into account.</p> <span class="elsevierStyleSectionTitle">Aim</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To determine the diagnostic yield, therapeutic changes, complications and mortality in patients with DLD on MV submitted to OLB.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of 19 patients admitted to S. João Hospital between January 1999 and July 2007 (8.5 years). Data analysed included demographic data, ventilation variables before and after biopsy, diagnostic yield, effect on subsequent treatment changes and complications of OLB. Statistical analysis was performed using SPSS 14.0.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The mean age of patients was 58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16.3 years old and 53% were male. The mean duration of hospital stay in Intensive Care Unit before performing OLB was 13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7 days. All biopsies were performed by thoracotomy. The diagnostic yield was 95%. There were no significant differences in partial pressure of arterial oxygen/fraction of inspired oxygen (PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span>) ratio and the positive end expiratory pressure (PEEP) before and after OLB. Postoperative complications occurred in 4 patients (21%; persistent air leak). Alteration in the diagnosis occurred in 14 patients (74%) and in 8 patients (42%) there was a modification in the treatment regimen. Global mortality was 47% (9 patients) but there were no biopsyrelated deaths.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The high diagnostic yield and the low incidence of complications make OLB a useful procedure in patients on MV with DLD of unknown aetiology. However, early OLB may lead to even better results in some patients.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle">Introdução</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A realização de biópsia pulmonar cirúrgica (BPC) em doentes sob ventilação invasiva (VI) no contexto de doenças difusas do pulmão (DPD) poderá revelar-se necessária em circunstâncias em que se torne fundamental a precisão diagnóstica, devendo obviamente ser ponderado o risco associado.</p> <span class="elsevierStyleSectionTitle">Objectivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliação da rentabilidade diagnóstica, alterações da orientação terapêutica, complicações e mortalidade em doentes com DPD sob VI, submetidos a BPC.</p> <span class="elsevierStyleSectionTitle">Material e métodos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospectivo de 19 doen tes admitidos no Hospital de S. João, num período de 8,5 anos (Janeiro 1999 – Julho 2007). Foram analisados os dados demográficos, as variáveis ventilatórias antes e após a BPC, a rentabilidade diagnóstica e o seu efeito na mudança terapêutica e as complicações da BPC. Análise estatística efectuada com SPSS 14.0.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A idade média dos doentes foi de 58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16,3 anos, e 53% eram do sexo masculino. A média de dias de internamento em unidade de cuidados intensivos (UCI) antes da realização da BPC foi de 13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7 dias. Todas as biópsias foram efectuadas por toracotomia. A rentabilidade diagnóstica foi de 95%. Apenas 4 doentes (21%) apresentaram complicações deste procedimento (fuga aérea prolongada). A razão pressão parcial do oxigénio arterial/ fracção de oxigénio inspirada (PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span>) e a pressão expiratória final positiva (PEEP) antes e após a BPC não mostraram diferenças significativas. Em 14 doentes (74%) o resultado histológico obtido levou à alteração da suspeita de diagnóstico inicial, condicionando em 8 deles (42%) uma mudança da orientação terapêutica. A mortalidade global foi de 47% (9 doentes), não se tendo observado em nenhum deles relação com o procedimento.</p> <span class="elsevierStyleSectionTitle">Conclusão</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A análise desta amostra sugere que a BPC poderá ser um procedimento de extrema utilidade em situações de diagnóstico indeterminado no contexto de doentes com DPD sob VI, para o que contribui a alta rentabilidade diagnóstica e a baixa incidência de complicações reveladas. 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| Year/Month | Html | Total | |
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