Transbronchial cryobiopsy in unexplained, severe ARDS: a single center retrospective case series
Abstract Background Acute respiratory distress syndrome (ARDS) deptics an acute form of lung infjury with often severe respiratory impairment that requires invasive mechanical ventilation. Since ARDS can be caused by several distinct etiologies, correct characterization is desired and frequently cha...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Pulmonary Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12890-022-02296-1 |
| _version_ | 1828069781676228608 |
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| author | Stephan Eisenmann Nina Lambrecht Linda Dießel Christin Busse Sebastian Nuding Alexander Vogt |
| author_facet | Stephan Eisenmann Nina Lambrecht Linda Dießel Christin Busse Sebastian Nuding Alexander Vogt |
| author_sort | Stephan Eisenmann |
| collection | DOAJ |
| description | Abstract Background Acute respiratory distress syndrome (ARDS) deptics an acute form of lung infjury with often severe respiratory impairment that requires invasive mechanical ventilation. Since ARDS can be caused by several distinct etiologies, correct characterization is desired and frequently challenging. Surgical lung biopsy was previously reported to be of additive value. We describe our institutional experience using transbronchial cryobiopsy (TBCB) for further characterization of severe and unexplained ARDS cases. Case presentation We retrospectively collected data of TBCB in patients with unexplained ARDS, whether with or without ECMO-support. Between 2019 and 2020 TBCB was performed in eight patients. Decision for the intervention was decided in multidisciplinary discussion. Five patients were treated with ECMO. The median duration of invasive ventilation before TBCB was 24 days. 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. Histology revealed five diffuses alveolar damage, one acute fibrinoid organizing pneumonia, one cryptogenic organizing pneumonia and one lung cancer. 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’ care. Side effects should be considered and monitored. |
| first_indexed | 2024-04-11T00:25:43Z |
| format | Article |
| id | doaj.art-f6324961a840476489cda90d4bd2bf6e |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-11T00:25:43Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-f6324961a840476489cda90d4bd2bf6e2023-01-08T12:04:00ZengBMCBMC Pulmonary Medicine1471-24662023-01-012311610.1186/s12890-022-02296-1Transbronchial cryobiopsy in unexplained, severe ARDS: a single center retrospective case seriesStephan Eisenmann0Nina Lambrecht1Linda Dießel2Christin Busse3Sebastian Nuding4Alexander Vogt5Department of Internal Medicine I, University Hospital HalleDepartment of Internal Medicine I, University Hospital HalleDepartment of Pathology, University Hospital HalleDepartment of Pathology, University Hospital HalleDepartment of Internal Medicine, IIIUniversity Hospital HalleDepartment of Internal Medicine, IIIUniversity Hospital HalleAbstract Background Acute respiratory distress syndrome (ARDS) deptics an acute form of lung infjury with often severe respiratory impairment that requires invasive mechanical ventilation. Since ARDS can be caused by several distinct etiologies, correct characterization is desired and frequently challenging. Surgical lung biopsy was previously reported to be of additive value. We describe our institutional experience using transbronchial cryobiopsy (TBCB) for further characterization of severe and unexplained ARDS cases. Case presentation We retrospectively collected data of TBCB in patients with unexplained ARDS, whether with or without ECMO-support. Between 2019 and 2020 TBCB was performed in eight patients. Decision for the intervention was decided in multidisciplinary discussion. Five patients were treated with ECMO. The median duration of invasive ventilation before TBCB was 24 days. 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. Histology revealed five diffuses alveolar damage, one acute fibrinoid organizing pneumonia, one cryptogenic organizing pneumonia and one lung cancer. 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’ care. Side effects should be considered and monitored.https://doi.org/10.1186/s12890-022-02296-1Transbronchial lung biopsyCryobiopsyARDSECMO |
| spellingShingle | Stephan Eisenmann Nina Lambrecht Linda Dießel Christin Busse Sebastian Nuding Alexander Vogt Transbronchial cryobiopsy in unexplained, severe ARDS: a single center retrospective case series BMC Pulmonary Medicine Transbronchial lung biopsy Cryobiopsy ARDS ECMO |
| title | Transbronchial cryobiopsy in unexplained, severe ARDS: a single center retrospective case series |
| title_full | Transbronchial cryobiopsy in unexplained, severe ARDS: a single center retrospective case series |
| title_fullStr | Transbronchial cryobiopsy in unexplained, severe ARDS: a single center retrospective case series |
| title_full_unstemmed | Transbronchial cryobiopsy in unexplained, severe ARDS: a single center retrospective case series |
| title_short | Transbronchial cryobiopsy in unexplained, severe ARDS: a single center retrospective case series |
| title_sort | transbronchial cryobiopsy in unexplained severe ards a single center retrospective case series |
| topic | Transbronchial lung biopsy Cryobiopsy ARDS ECMO |
| url | https://doi.org/10.1186/s12890-022-02296-1 |
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