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Ann Thorac Surg 2006;82:261-266
© 2006 The Society of Thoracic Surgeons

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Original article: General thoracic

Mechanical Ventilation and Air Leaks After Lung Biopsy for Acute Respiratory Distress Syndrome

^a Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center
^b Division of Cardiology, Beth Israel Deaconess Medical Center
^c Department of Medicine, Brigham and Women's Hospital
^d Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
^e Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
^f Department of Pulmonary and Critical Care Division, University Hospitals of Cleveland, Cleveland, Ohio

Accepted for publication February 6, 2006.

^_* Address correspondence to Dr Cho, Brookline Avenue KS-B23, Boston, MA 02215 (Email: mcho{at}bidmc.harvard.edu).

BACKGROUND: Open lung biopsy in acute respiratory distress syndrome (ARDS) may provide a specific etiology and change clinical management, yet concerns about complications remain. Persistent air leak is the most common postoperative complication. Risk factors in this setting are not known.

METHODS: We performed a retrospective analysis of 53 patients who underwent open lung biopsy for clinical ARDS (based on American European Consensus Conference criteria) between 1989 and 2000.

RESULTS: Sixteen patients (30.2%) developed an air leak lasting more than 7 days or died with an air leak. Univariate analyses showed no significant correlation with age, gender, sex, corticosteroid use, diabetes, immunocompromised status, or pathologic diagnosis. A lower risk of air leak was associated with lower peak airway pressure and tidal volume, use of pressure-cycled ventilation, and use of an endoscopic stapling device. In multivariate analyses, only peak airway pressure remained a significant predictor. The risk of prolonged air leak was reduced by 42% (95% confidence interval [CI: 17% to 60%]) for every 5 cm H₂O reduction in peak airway pressure.

CONCLUSIONS: The use of a lung-protective ventilatory strategy that limits peak airway pressures is strongly associated with a reduced risk of postoperative air leak after open lung biopsy in ARDS. Using such a strategy may allow physicians to obtain information from open lung biopsy to make therapeutic decisions without undue harm to ARDS patients.

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				A. Brunelli Invited commentary. Ann. Thorac. Surg., July 1, 2006; 82(1): 267 - 267. [Full Text] [PDF]