Outcome and Post-Surgical Lung Biopsy Change in Management of ARDS: A Proportional Prevalence Meta-Analysis

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: Background: Limited epidemiological data are available on changes in management, benefits, complications, and outcomes after open lung biopsy in patients with ARDS. Methods: We performed a literature search of PubMed, Ovid, and Cochrane databases for articles from the inception of each database till November 2020 that provided outcomes of lung biopsy in ARDS patients. The primary outcome was the proportion of patients that had a change in management with alteration of treatment plan, after lung biopsy. Secondary outcomes included pathological diagnoses and complications related to the lung biopsy. Pooled proportions with a 95% confidence interval (CI) were calculated for the prevalence of outcomes. Results: After analysis of 22 articles from 1994 to 2018, a total of 851 ARDS patients (mean age 59.28 ± 7.41, males 56.4%) that were admitted to the ICU who underwent surgical lung biopsy for ARDS were included. Biopsy changed the management in 539 patients (pooled proportion 75%: 95% CI 64–84%). There were 394 deaths (pooled proportion 49%: 95% CI 41–58%). The most common pathologic diagnosis was diffuse alveolar damage that occurred in 30% (95% CI 19–41%), followed by interstitial lung disease in 10% (95% CI 3–19%), and viral infection in 9% (95% CI 4–16%). Complications occurred among 201 patients (pooled proportion 24%, 95% CI 17–31%). The most common type of complication was persistent air-leak among 115 patients (pooled estimate 13%, 95% CI 9–17%). Conclusion: Despite the high mortality risk associated with ARDS, lung biopsy changed management in about 3/4 of the patients. However, 1/4 of the patients had a complication due to lung biopsy. The risks from the procedure should be carefully weighed before proceeding with lung biopsy.