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Acute respiratory insufficiency resulting from diffuse diseases in the pulmonary parenchyma is a severe condition that presents high mortality rates and, consequently, requires early appropriate treatment. In recent decades, there have been advances in measures for ventilatory, hemodynamic, and nutritional support, as well as for substitution of renal function and infection control, all of which have, overall, been improving survival in intensive care units. However, despite the efficacy of all of these support measures, patient recovery depends on the specific treatment of the disease, which must therefore be identified. At this point, cases of diffuse pulmonary infiltrate in critical patients pose a great challenge, since there are a number of diagnostic hypotheses, and because the results of clinical tests and less invasive complementary examinations do not always provide sufficient data to differentiate among these hypotheses. Lung biopsy may be the only means of making a definitive diagnosis, although it is an invasive procedure that should only be performed in patients with severe forms of disease. Infectious diseases are generally the first to come to mind in cases of acute respiratory insufficiency with diffuse pulmonary infiltrate. This is relevant because they constitute the most common etiologies in this situation. However, there are numerous infectious etiologic agents (bacteria, fungi and viruses) that can be implicated in isolation or in combination. Such agents include Pneumocystis carinii/jiroveci, Mycobacterium tuberculosis, other mycobacteria and Nocardia. (1-2) In the absence of an etiological diagnosis, broad-spectrum antimicrobial treatment regimens tend to be used and are frequently extended over the course of the treatment if a satisfactory response is not obtained. These treatments expose the patients to side effects from a great number of antibiotics, increase the risk of nosocomial infection, facilitate the emergence of resistant strains, and are costly. In addition,

Infiltrado pulmonar no paciente crítico: a importância da biópsia pulmonar