Transbronchial lung cryobiopsy may be of value for nonresolving acute respiratory distress syndrome: case series and systematic literature review

Guowu Zhou, Yingying Feng, Shiyao Wang, Yi Zhang, Ye Tian, Xiaojing Wu, Ling Zhao, Dan Wang, Ying Li, Zheng Tian, Qingyuan Zhan, Guowu Zhou, Yingying Feng, Shiyao Wang, Yi Zhang, Ye Tian, Xiaojing Wu, Ling Zhao, Dan Wang, Ying Li, Zheng Tian, Qingyuan Zhan

Abstract

Background: Identification of pathologic features is helpful for the management of nonresolving acute respiratory distress syndrome (ARDS). Transbronchial lung cryobiopsy (TBLC) is a novel biopsy technique that may have comparable utility to surgical biopsy. The aim of this study was to assess the value of TBLC in patients with nonresolving ARDS.

Methods: All patients with nonresolving ARDS who underwent TBLC from January 2019 to August 2019 in a tertiary medical ICU were included. In addition, a literature search of TBLC for ARDS was performed by searching PubMed, EMBASE, ATS/ERS/APSR meeting abstracts, ClinicalTrials.gov , and Google Scholar. Data on complications, histologic diagnosis, management changes, and outcomes were analysed.

Results: Five patients (three women and two men) underwent TBLC. None of the patients developed pneumothorax, although two patients developed massive bleeding, which was controlled by continuous occlusion using bronchial blockers. There were no procedure-related deaths. Diffuse alveolar damage (DAD) and alternative histologic patterns were found in two and three patients, respectively, resulting in management changes in all cases. The literature search yielded four studies, which together with the present study comprised data from 25 cases in which TBLC was used in nonresolving ARDS. The summary diagnostic yield was 92% (23/25). Only 44% (11/25) of cases were proven to be DAD. TBLC contributed to management changes in 80% of patients (20/25). Procedure-related complications consisted of pneumothorax (16%, 4/25), significant bleeding (12%, 3/25), and persistent air leaks (8%, 2/25). There were no procedure-related deaths. The follow-up survival rate was 61.9% (13/21).

Conclusions: The complications of TBLC in selected patients with nonresolving ARDS may be acceptable. The procedure may have a high diagnostic yield and can lead to a re-evaluation of the diagnosis as well as changes in patient management. Further investigations with larger sample sizes are required.

Keywords: ARDS; Biopsy; Diagnostic yield; Safety; TBLC.

Conflict of interest statement

All authors declare no competing interests in this study.

Figures

Fig. 1
Fig. 1
Radial probe endobronchial ultrasound (RP-EBUS) guided transbronchial lung cryobiopsy (TBLC) for acute respiratory distress syndrome (ARDS). a RP-EBUS screening of the target biopsy position. b Marking the biopsy distance on the cryoprobe compared to that on RP-EBUS. c1 Prophylactic placement of the bronchial blocker and insertion of the cryoprobe into the target segment. c2 Combined guidance with cone beam CT after placing the cryoprobe in patient 5. d Transbronchial lung cryobiopsy was performed after freezing for 4 s. e The bronchial blocker was filled to stop the bleeding. f Bronchial blockers were continuously placed in target bronchi for patients with massive bleeding
Fig. 2
Fig. 2
Specimens and histology obtained by transbronchial lung cryobiopsy for acute respiratory distress syndrome. a Gross specimens and their sizes. b Histologic diagnosis of foreign body granulomas in patient 3
Fig. 3
Fig. 3
Flow diagram of the literature search and study selection process

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Source: PubMed

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