Complications of a lung biopsy for severe respiratory failure: A systematic review and meta- analysis

Background: This systematic review and meta-analysis aimed to evaluate the complications of lung biopsy in patients with acute respiratory failure (ARF), including acute respiratory distress syndrome (ARDS).Methods: We searched the MEDLINE and Cochrane Central Register of Controlled Trials. The primary outcomes were biopsy-related death, respiratory failure, cardiac complications, bleeding, and other major complications. We used the McMaster Quality Assessment Scale of Harms (McHarm) to evaluate the risk of bias. A random-effects model was used to calculate the pooled frequencies.Results: Thirteen studies (consisting of 574 patients) were included in the meta-analysis. Furthermore, most of the included studies had a high or unclear risk of bias in half of the items in McHarm. All included studies evaluated surgical lung biopsies. The median overall hospital mortality was 53% (range: 17%-90%). The pooled frequencies of biopsy-related death, respiratory failure, cardiac complication, bleeding, and other major com-plications were 0.00% (95% confidence interval [CI]: 0.00%-0.21%), 1.30% (95% CI: 0.00%-5.69%), 1.03% (95% CI: 0.00%-3.73%), 1.46% (95% CI: 0.16%-3.56%), and 4.26% (95% CI: 0.00%-13.0%), respectively. Conclusions: The results of this study will be valuable information in considering the in-dications of lung biopsy in patients with ARF, including ARDS.Trial registration: The protocol was registered with the University Hospital Medical Infor-mation Network Clinical Trials Registry (UMIN 000040650).(c) 2022 [The Author/The Authors] Published by Elsevier B.V. on behalf of The Japanese Respiratory Society. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).