Transbronchial Cryobiopsy in Unexplained, Severe ARDS – A Single Center Retrospective Case Series

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a common cause of severe respiratory impairment. It needs a correct characterization which often is challenging. Additional surgical lung biopsy was previously reported to be of additive value. In severe and unexplained ARDS we tried to define an additional diagnostic benefit of transbronchial cryobiopsy (TBCB). Method: We retrospectively collected data of TBCB in unexplained ARDS, whether with or without ECMO-support. TBCB was performed in one segment, that was prophylactically occluded by Watanabe spigot or swab after the procedure. Histology results and their contribution to further therapeutic decisions were analyzed. Results: Between 2019 and 2020 TBCB was performed in six patients. Decision for the intervention was decided in multidisciplinary discussion before. Three patients were treated with ECMO. The median duration of invasive ventilation before TBCB was 24 days. Histology revealed four diffuses alveolar damage, one acute fibrinoid organizing pneumonia and one cryptogenic organizing pneumonia. All results contributed to the decision of further management. While no pneumothorax or severe endobronchial bleeding occurred, two delayed hematothoraces needed surgical treatment. No patients died due to TBCB.Conclusion: TBCB is feasible in ARDS even during ECMO treatment. Histologic results can play a significant role in therapeutic and ethic discussion to guide the patients’ path. Side effects should be considered and monitored.