The utility of surgical lung biopsy in cancer patients with acute respiratory distress syndrome

Chang, Chih‐Hao; Kao, Kuo‐Chin; Hu, Han‐Chung; Hung, Cheng‐Chieh; Li, Lifu; Wu, Chiung-Jen; Wang, Chih‐Wei; Fu, Jui-Ying; Huang, Chung-Chi; Chen, Ning‐Hung; Yang, Cheng‐Ta; Tsai, Ying‐Huang

doi:10.1186/1749-8090-8-128

Cited by 2 publications

(2 citation statements)

References 24 publications

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“…The ARDS severity was characterized at the time of diagnosis. These 101 patients included patients previously identified using the AECC definition of ARDS, but reanalyzed in this study according to the Berlin definition of ARDS [ 16 , 25 ].…”

Section: Methodsmentioning

confidence: 99%

Diffuse alveolar damage associated mortality in selected acute respiratory distress syndrome patients with open lung biopsy

Kao

Chang

et al. 2015

Crit Care

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IntroductionDiffuse alveolar damage (DAD) is the pathological hallmark of acute respiratory distress syndrome (ARDS), however, the presence of DAD in the clinical criteria of ARDS patients by Berlin definition is little known. This study is designed to investigate the role of DAD in ARDS patients who underwent open lung biopsy.MethodsWe retrospectively reviewed all ARDS patients who met the Berlin definition and underwent open lung biopsy from January 1999 to January 2014 in a referred medical center. DAD is characterized by hyaline membrane formation, lung edema, inflammation, hemorrhage and alveolar epithelial cell injury. Clinical data including baseline characteristics, severity of ARDS, clinical and pathological diagnoses, and survival outcomes were analyzed.ResultsA total of 1838 patients with ARDS were identified and open lung biopsies were performed on 101 patients (5.5 %) during the study period. Of these 101 patients, the severity of ARDS on diagnosis was mild of 16.8 %, moderate of 56.5 % and severe of 26.7 %. The hospital mortality rate was not significant difference between the three groups (64.7 % vs 61.4 % vs 55.6 %, p = 0.81). Of the 101 clinical ARDS patients with open lung biopsies, 56.4 % (57/101) patients had DAD according to biopsy results. The proportion of DAD were 76.5 % (13/17) in mild, 56.1 % (32/57) in moderate and 44.4 % (12/27) in severe ARDS and there is no significant difference between the three groups (p = 0.113). Pathological findings of DAD patients had a higher hospital mortality rate than non-DAD patients (71.9 % vs 45.5 %, p = 0.007). Pathological findings of DAD (odds ratio: 3.554, 95 % CI, 1.385–9.12; p = 0.008) and Sequential Organ Failure Assessment score on the biopsy day (odds ratio: 1.424, 95 % CI, 1.187–1.707; p<0.001) were significantly and independently associated with hospital mortality. The baseline demographics and clinical characteristics were not significantly different between DAD and non-DAD patients.ConclusionsThe correlation of pathological findings of DAD and ARDS diagnosed by Berlin definition is modest. A pathological finding of DAD in ARDS patients is associated with hospital mortality and there are no clinical characteristics that could identify DAD patients before open lung biopsy.

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Section: Methodsmentioning

confidence: 99%

Diffuse alveolar damage associated mortality in selected acute respiratory distress syndrome patients with open lung biopsy

Kao

Chang

et al. 2015

Crit Care

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“…When lung disease progresses, open lung biopsy, TBLB, and TBLC may be helpful to make a definite diagnosis [ 39 ]. In critically ill patients with cancer diagnosed with ARDS, biopsy findings have resulted in a change in therapy in 69% of patients [ 40 ]. Combined BAL and TBLB are better than BAL alone in the diagnosis of pulmonary neoplastic infiltration in patients with hematologic malignancies [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of Transbronchial Lung Cryobiopsy for Diagnosis of Acute Respiratory Failure with Mechanical Ventilation in Intensive Care Unit

Chang

et al. 2022

Diagnostics

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Background: Acute hypoxemic respiratory failure is common in intensive care units (ICUs). Lung biopsies may be required to make a definitive diagnosis in patients with unknown etiologies. The feasibility of transbronchial lung cryobiopsy is undetermined in patients with respiratory failure in the ICU. Methods: Patients who underwent bronchoscopy examinations with transbronchial lung cryobiopsy (TBLC) between July 2018 and December 2019 were retrospectively analyzed through medical chart review. The procedures were performed by well-experienced interventional pulmonologists. Results: Ten patients underwent bronchoscopy examinations with TBLC in the ICU at Chang Gung Memorial Hospital during the study period. In all patients, the diagnosis was made via pathological analysis. One patient developed pneumothorax and required chest tube placement after the procedure. None of the patients had bleeding requiring blood transfusion, and no deaths were directly related to the procedure. Conclusions: TBLC is a feasible technique to obtain lung pathology in patients with acute respiratory diseases of unknown etiologies. While the complication rate may be acceptable, the procedure should be performed by experienced interventional pulmonologists. However, airway blockers and fluoroscopy are highly recommended when used according to the current guideline. We do not encourage TBLC to be performed without having airway blockers available at the bedside.

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The utility of surgical lung biopsy in cancer patients with acute respiratory distress syndrome

Cited by 2 publications

References 24 publications

Diffuse alveolar damage associated mortality in selected acute respiratory distress syndrome patients with open lung biopsy

Diffuse alveolar damage associated mortality in selected acute respiratory distress syndrome patients with open lung biopsy

Feasibility and Safety of Transbronchial Lung Cryobiopsy for Diagnosis of Acute Respiratory Failure with Mechanical Ventilation in Intensive Care Unit

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