Outcome and Post-Surgical Lung Biopsy Change in Management of ARDS: A Proportional Prevalence Meta-Analysis
Abstract
:Highlights
- Lung biopsy in ARDS patients lead to a change in management in 3/4 patients.
- Despite changes in management and pathology-directed treatment, there was significant mortality in ARDS patients who had lung biopsy.
- High rates of complications from lung biopsy were observed in ARDS patients who had lung biopsy.
Abstract
1. Introduction
2. Methods
2.1. Search Strategy
2.2. Data Extraction
2.3. Outcomes
2.4. Statistical Analysis
3. Results
3.1. Search Results and Study Characteristics
3.2. Primary Outcomes
3.3. Secondary Outcomes
3.3.1. Complications
Regression Analysis
3.3.2. Pathologic Diagnosis
Quality of the Included Studies
4. Discussion
4.1. High Risk of Mortality with Lung Biopsy in ARDS
4.2. Pathological Diagnoses on Lung Biopsy and Change in Management
4.3. High Complication Rate with Lung Biopsy
5. Conclusions
Take Home Message
- Lung biopsy in ARDS patients leads to a change in management in 3/4 of patients.
- Despite a change in management and pathology-directed treatment, there was significant mortality in ARDS patients who had a lung biopsy.
- High rates of complications from lung biopsy were observed in ARDS patients who had a lung biopsy.
- The decision for lung biopsy in ARDS patients should be individualized considering the complications and mortality rates.
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
References
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Study | Country | Study Type | n | Age (Mean ± SD) | Males n (%) | PaO2/FiO2 (mmHg) Mean ± SD | PEEP (cm H2O), Mean ± SD |
---|---|---|---|---|---|---|---|
Ortiz 2018 [14] | Columbia | Retrospective | 15 | 42 ± 18 | 7 (47) | 121 ± 0 | 13 ± 0 |
Philipponnet 2018 [15] | France | Retrospective | 46 | 69 ± 5 | 33 (71) | 180 ± 89 | - |
Gerard 2018 [16] | Belgium | Retrospective | 51 | 65 ± 7 | 28 (55) | 128 ± 0 | 9 ± 2 |
Almotairi 2016 [17] | Canada | Retrospective | 76 | 63 ± 4 | 41 (54) | 136 ± 24 | - |
Guerin 2015 [18] | France | Retrospective | 83 | 64 ± 6 | 35 (56) | - | - |
Depuydt 2013 [19] | Belgium | Retrospective | 60 | 62 ± 14 | 36 (60) | 189 ± 0 | 8 ± 1 |
Melo 2009 [20] | Portugal | Retrospective | 19 | 58 ± 16 | 10 (53) | 171 ± 0 | 9 ± 0 |
Charbonney 2009 [21] | Switzerland | Retrospective | 19 | 50 ± 5 | 11 (58) | 119 ± 34 | 6 ± 3 |
Baumann 2008 [22] | Germany | Retrospective | 27 | 48 ± 14 | 12 (44) | 188 ±109 | - |
Arabi 2007 [23] | Saudi Arabia | Retrospective | 14 | 51 ± 19 | 7 (50) | 150 ± 60 | 8 ± 4 |
Lim 2007 [24] | South Korea | Retrospective | 36 | 59 ± 0 | 25 (69) | 159 ± 0 | 11 ± 4 |
Papazian 2007 [25] | France | Prospective | 100 | 57 ± 17 | 67 (67) | 129 ± 14 | 10 ± 3 |
Barbas 2006 [26] | Brazil | Retrospective | 12 | 65 ± 14 | 5 (42) | 157 ± 0 | - |
Kao 2006 [12] | Taiwan | Retrospective | 41 | 55 ± 17 | 28 (68) | 116 ± 43 | 11 ± 3 |
Soh 2005 [13] | Taiwan | Retrospective | 32 | 51 ± 22 | 24 (75) | 163 ± 90 | - |
Kapala 2005 [27] | Brazil | Retrospective | 13 | 66 ± 0 | - | - | - |
Monteiro 2005 [28] | Brazil | Retrospective | 24 | 65 ± 0 | 12 (50) | - | - |
Patel 2004 [29] | USA | Retrospective | 57 | 53 ± 18 | 36 (65) | 145 ± 61 | 10 ± 4 |
Flabouris 1999 [30] | Australia | Retrospective | 24 | 49 ±16 | 8 (33) | 161 ± 0 | - |
Papazian 1998 [8] | France | Prospective | 36 | 59 ± 15 | - | 122 ± 37 | 10 ± 0 |
Hughes 1997 [31] | Canada | Retrospective | 27 | 57 ± 0 | 14 (52) | - | - |
Canver 1994 [32] | USA | Retrospective | 92 | 51 ± 5 | 13 (48) | - | 9 ± 1 |
Univariate: Coefficient of Variation (p) | Multivariate: Coefficient of Variation (p) | |||||
---|---|---|---|---|---|---|
Age | Male | Study Type | Age | Male | Study Type | |
Air-leak | 0.98 (0.5) | 1.01 (0.2) | 0.57 (0.1) | 0.97 (0.3) | 1.02 (0.76) | 0.36 (0.06) |
Morality | 1.02 (0.1) | 1.00 (0.6) | 0.89 (0.6) | 1.01 (0.1) | 1.00 (0.9) | 0.85 (0.6) |
Complications | 0.98 (0.4) | 1.00 (0.6) | 0.87 (0.7) | 0.98 (0.3) | 1.01 (0.5) | 1.20 (0.7) |
CIM | 1.01 (0.2) | 1.00 (0.9) | 1.18 (0.4) | 1.01 (0.3) | 1.00 (0.7) | 1.11 (0.7) |
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Mir, T.; Regmi, N.; Saydain, G.; Kaul, V.; Soubani, A.O.; Qureshi, W.T. Outcome and Post-Surgical Lung Biopsy Change in Management of ARDS: A Proportional Prevalence Meta-Analysis. Adv. Respir. Med. 2022, 90, 267-278. https://doi.org/10.3390/arm90040036
Mir T, Regmi N, Saydain G, Kaul V, Soubani AO, Qureshi WT. Outcome and Post-Surgical Lung Biopsy Change in Management of ARDS: A Proportional Prevalence Meta-Analysis. Advances in Respiratory Medicine. 2022; 90(4):267-278. https://doi.org/10.3390/arm90040036
Chicago/Turabian StyleMir, Tanveer, Neelambuj Regmi, Ghulam Saydain, Viren Kaul, Ayman O. Soubani, and Waqas T. Qureshi. 2022. "Outcome and Post-Surgical Lung Biopsy Change in Management of ARDS: A Proportional Prevalence Meta-Analysis" Advances in Respiratory Medicine 90, no. 4: 267-278. https://doi.org/10.3390/arm90040036