Identification of pathologic features is helpful for the management of nonresolving acute respiratory\ndistress syndrome (ARDS). Transbronchial lung cryobiopsy (TBLC) is a novel biopsy technique that may have\ncomparable utility to surgical biopsy. The aim of this study was to assess the value of TBLC in patients with\nnonresolving ARDS.\nMethods: All patients with nonresolving ARDS who underwent TBLC from January 2019 to August 2019 in a\ntertiary medical ICU were included. In addition, a literature search of TBLC for ARDS was performed by searching\nPubMed, EMBASE, ATS/ERS/APSR meeting abstracts, ClinicalTrials.gov, and Google Scholar. Data on complications,\nhistologic diagnosis, management changes, and outcomes were analysed.\nResults: Five patients (three women and two men) underwent TBLC. None of the patients developed pneumothorax,\nalthough two patients developed massive bleeding, which was controlled by continuous occlusion using bronchial\nblockers. There were no procedure-related deaths. Diffuse alveolar damage (DAD) and alternative histologic patterns\nwere found in two and three patients, respectively, resulting in management changes in all cases. The literature search\nyielded four studies, which together with the present study comprised data from 25 cases in which TBLC was used in\nnonresolving ARDS. The summary diagnostic yield was 92% (23/25). Only 44% (11/25) of cases were proven to be DAD.\nTBLC contributed to management changes in 80% of patients (20/25). Procedure-related complications consisted of\npneumothorax (16%, 4/25), significant bleeding (12%, 3/25), and persistent air leaks (8%, 2/25). There were no\nprocedure-related deaths. The follow-up survival rate was 61.9% (13/21).\nConclusions: The complications of TBLC in selected patients with nonresolving ARDS may be acceptable. The\nprocedure may have a high diagnostic yield and can lead to a re-evaluation of the diagnosis as well as changes in\npatient management. Further investigations with larger sample sizes are required.
Loading....