Original articleGeneral thoracicSurgical Lung Biopsy in Adult Respiratory Distress Syndrome: A Meta-Analysis
Section snippets
Material and Methods
English language studies of acute respiratory failure and diffuse pulmonary infiltrates were eligible for the meta-analysis if they fulfilled the following criteria: original publication evaluating the use of OLB as a diagnostic tool and the inclusion of predominantly ventilated adult patients. Exclusion criteria were studies conducted solely on pediatric patients and studies that contained no ventilated patients. Five outcomes of interest were hospital mortality rate, surgical complication
Results
The frequency of making a specific diagnosis by OLB specimen was examined. The Cochrane Q statistical heterogeneity test had a p value of less than 0.0001. The random-effects (DerSimonian-Laird) pooled proportion for the specific diagnosis rate was 0.84 (95% confidence interval, 0.75 to 0.92; Appendix Table 2 and Fig 2A). One study was excluded due to lack of available data on specific diagnosis.
The frequency of each pathologic diagnosis is shown in Figure 3 (also see Appendix Table 3). The
Comment
Although diagnostic techniques such as BAL are commonly performed in patients with ARDS, they uncommonly lead to a specific diagnosis: 70% of patients had at least 1 bronchoscopy with BAL before OLB, but in only 10% was BAL was consistent with the pathologic diagnosis from OLB. The high mortality rate of ARDS without a specific diagnosis raises the question of whether OLB should be performed. Several studies (Appendix Table 1) have examined OLB in patients who are critically ill, mechanically
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