Patients With ARF/ARDS Experienced No Death, Few Complications From Lung Biopsy

Lung biopsies aimed at identifying the underlying causes of acute respiratory failure and ARDS present no mortality risk.

Patients with acute respiratory failure (ARF), including those with acute respiratory distress syndrome (ARDS), experienced no deaths and few complications from undergoing a lung biopsy, according to review and meta-analysis results published in Respiratory Investigation.

Although lung biopsies have been suggested as a means of verifying the causes of ARF and ARDS, the safety of such biopsies has been unclear. Investigators in Japan therefore sought to assess patients with ARF or ARDS for complications of lung biopsy. Primary endpoints included cardiac complications, respiratory failure, bleeding, other major complications, and biopsy-related death.

The researchers conducted a systematic review and meta-analysis of 13 studies (2 prospective cohort studies, and 11 retrospective cohort studies) that included 574 patients. These studies, which all evaluated surgical lung biopsies, were published in English and found in the MEDLINE and Cochrane Central Register of Controlled Trials through May 2020. Patients included were at least 16 years of age, were critically ill with ARF or ARDS and had received care in the intensive care unit or emergency department, and had required mechanical ventilation.

Investigators found median overall hospital mortality was 53% (range 17%-90%), and that no biopsy-related deaths were reported under this median. Pooled frequencies for cardiac complications were 1.03% (95% CI, 0.00%-3.73%); respiratory failure, 1.30% (95% CI, 0.00%-5.69%); bleeding, 1.46% (95% CI, 0.16%-3.56%); other major complications, 4.26% (95% CI, 0.00%-13.0%), and biopsy-related death, 0.00% (95% CI, 0.00%-0.21%).

With respect to secondary outcomes, investigators found that the pooled frequencies were as follows: infections, 2.70%; (95% CI, 0.00%-12.6%, I2= 76.8%); pneumothorax, 6.51% (95% CI, 1.89%-13.0%, I2=70.0%); and minor complications (persistent air leak, bronchopleural fistula, subcutaneous emphysema), 16.4% (95% CI, 9.71%-24.3%, I2=77.7%).

The pooled frequencies of biopsy related death, respiratory failure, cardiac complication, bleeding, and other major complications were 0.00%.

Significant study limitations include a lack of randomized controlled trials and only 2 prospective cohort studies included in the meta-analysis; underpowered sample size to evaluate biopsy-related death; the use of studies known to have high bias risk and a poor-quality study design; and difficulty in distinguishing biopsy-related deaths from those caused by underlying disease. Investigators also noted that real-world data reveal a 16% in-hospital mortality rate for non-elective lung biopsy, suggesting their meta-analysis results may be underestimated.

The investigators concluded that “The pooled frequencies of biopsy related death, respiratory failure, cardiac complication, bleeding, and other major complications were 0.00%.” Moreover, they added, “In this study, serious complications of lung biopsy were less than 5%, with the most common complication being persistent air leak.” These results may be valuable for helping clinicians determine the feasibility of performing a lung biopsy in patients with ARF and ARDS, said study authors.


Sugimoto H, Fukuda Y, Yamada Y, et al. Complications of a lung biopsy for severe respiratory failure: A systematic review and meta-analysis. Respir Investig. Published online September 23, 2022. doi:10.1016/j.resinv.2022.08.008