Open-lung Biopsy in Patients with Acute Respiratory Distress Syndrome

Papazian, Laurent; Thomas, Philippe; Brégeon, Fabienne; Garbe, L; Zandotti, Christine; Saux, P.; Gaillat, F.; Drancourt, Michel; Auffray, Jean-Pierre; Gouin, F.

doi:10.1097/00000542-199804000-00013

Cited by 123 publications

(82 citation statements)

References 28 publications

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“…Results were similar in a sensitivity analysis among five studies (8,(11)(12)(13)(14), including 261 patients and 267 histopathological diagnoses specifically identifying patients using AmericanEuropean Consensus definition of acute lung injury. The most common diagnoses remained fibrosis/pneumonitis (26%; 95% CI, 11-46%), followed by infection (25%; 95% CI, 18-32%) and diffuse alveolar damage (20%; 95% CI, 10-32%).…”

Section: Systematic Reviewmentioning

confidence: 67%

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Open Lung Biopsy among Critically Ill, Mechanically Ventilated Patients: A Meta-Analysis

Wong

Walkey

2015

Annals ATS

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Rationale: Open lung biopsy may be performed to guide therapy in mechanically ventilated patients with diagnostic uncertainty regarding etiology of pulmonary infiltrates. Current evidence for open lung biopsy in mechanically ventilated patients comes from single-center case series.Objectives: We performed a metaanalysis of case series to determine diagnoses, complications, and changes in therapy after lung biopsy in critically ill patients requiring mechanical ventilation. Methods:We searched Medline for case series of lung biopsies in critically ill patients requiring mechanical ventilation. We pooled results of individual case series using random effects metaanalysis models to obtain summary proportions. Measurements and Main Results:We identified 14 case series including a total of 512 mechanically ventilated patients with 530 histopathological diagnoses. The most common diagnoses were "fibrosis/pneumonitis" (n = 155, 25%; 95% confidence interval [CI], 14-37%) and infection (n = 113, 20%; 95% CI, 15-27%). Viruses were the most commonly identified infectious etiology identified on open lung biopsy, representing 50% of potential pathogens. Diffuse alveolar damage was present in a minority of specimens (n = 100, 16%; 95% CI, 8-25%). Therapeutic changes after lung biopsy occurred in 399 patients (78%; 95% CI, 64-81%). Procedure-related complications occurred in 29% of patients (95% CI, 25-33%), most commonly persistent air leak. Mortality among mechanically ventilated patients after diagnostic open lung biopsy was 54%.Conclusions: Among mechanically ventilated patients with respiratory failure of unclear etiology, lung biopsy yielded a wide range of diagnoses and was associated with a change in therapy in most patients.

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Section: Systematic Reviewmentioning

confidence: 67%

“…Patient mortality (defined variably as hospital, intensive care unit, or 28-30 days after open lung biopsy) was 54%. Mortality rates stratified by histopathological diagnosis did not differ significantly by diagnosis (P = 0.15; Table 2, reported in eight studies) (4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Systematic Reviewmentioning

confidence: 95%

Open Lung Biopsy among Critically Ill, Mechanically Ventilated Patients: A Meta-Analysis

Wong

Walkey

2015

Annals ATS

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“…Lung specimens from ARDS patients were obtained by open lung biopsy or autopsy at the Sainte Marguerite Hospital, Marseille, France, and frozen immediately at -80˚C for subsequent examination. Open lung biopsies were performed for clinical reasons, as detailed elsewhere [10]. The controls were patients undergoing thoracic surgery to treat nonsmall cell lung cancers, in whom lung tissue (normal appearance on microscopic examination) was sampled at a distance from the tumour area and processed as for the ARDS patients.…”

Section: Methodsmentioning

confidence: 99%

Decreased VEGF concentration in lung tissue and vascular injury during ARDS

Abadie

Brégeon²,

Papazian³

et al. 2005

Eur Respir J

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Endothelial injury is an important prognostic factor in acute respiratory distress syndrome (ARDS). Decreased production of vascular endothelial growth factor (VEGF) in ARDS may favour vascular lesions, since VEGF promotes endothelial survival by inhibiting apoptosis.This study sought to document low VEGF levels in lung tissue from ARDS patients, to determine whether the cause was injury to alveolar type II cells (the main pulmonary source of VEGF) and to evaluate the vascular consequences. Lung specimens were obtained by open biopsy or autopsy from 29 patients with severe ARDS (two survivors) and five controls.As compared with controls, homogenates of lung tissue from ARDS patients contained less VEGF (median (interquartile range) ARDS 8.2 (4.7-12.2) versus controls 28.4 (9.9-47.1) ng?g -1 protein). Increased immunostaining with surfactant protein B was seen in ARDS lungs. Extensive cellular apoptosis (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labelling staining), including endothelial and alveolar type II cells, was demonstrated, and vascular bed density (CD31 immunostaining) decreased in ARDS lungs as compared with controls. VEGF levels were negatively correlated to apoptotic endothelial cell counts.In conclusion, decreased vascular endothelial growth factor levels in lung tissue may participate in the decrease in lung perfusion in acute respiratory distress syndrome.

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“…Hospital mortality rates from similar but smaller series of hypoxic patients undergoing SLB are consistent with our experience, ranging from 50% to 70%. [3][4][5][6][7] In contrast, reported mortality rates for all patients (hypoxic and nonhypoxic) undergoing SLB tend to be lower. 4,[8][9][10] Greenman and coworkers 11 found a 73% mortality rate in hypoxic (PaO 2 < 55 mm Hg) immunosuppressed patients and a 39% mortality rate in nonhypoxic patients.…”

Section: Discussionmentioning

confidence: 94%

Correlation Between Surgical Lung Biopsy and Autopsy Findings and Clinical Data in Patients With Diffuse Pulmonary Infiltrates and Acute Respiratory Failure

Canzian

Soeiro

Taga

et al. 2006

Clinics

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Open-lung Biopsy in Patients with Acute Respiratory Distress Syndrome

Abstract: Open lung biopsy appeared to be a useful and acceptably safe diagnostic technique in patients with ARDS. It permitted the diagnosis of unexpected cytomegalovirus pneumonia.

Cited by 123 publications

References 28 publications

Open Lung Biopsy among Critically Ill, Mechanically Ventilated Patients: A Meta-Analysis

Open Lung Biopsy among Critically Ill, Mechanically Ventilated Patients: A Meta-Analysis

Decreased VEGF concentration in lung tissue and vascular injury during ARDS

Correlation Between Surgical Lung Biopsy and Autopsy Findings and Clinical Data in Patients With Diffuse Pulmonary Infiltrates and Acute Respiratory Failure

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