The following is the summary of “Transbronchial cryobiopsy in unexplained, severe ARDS: a single center retrospective case series” published in the January 2023 issue of Pulmonary medicine by Eisenmann, et al.
Acute lung injury that causes Acute respiratory distress syndrome (ARDS) causes significant respiratory impairment and frequently necessitates invasive mechanical ventilation. Correct categorization is desirable and often difficult because ARDS can have multiple causes. The benefits of surgical lung biopsy have already been reported. Here, researchers provide their institution’s knowledge gained by transbronchial cryo-biopsy (TBCB) for better characterizing patients of severe, unexplained ARDS.
Researchers conducted a retrospective study of TBCB in ECMO-supported and non-ECMO-supported patients with ARDS of unknown cause. In the years 2019 and 2020,8, individuals underwent TBCB. The decision to intervene was reached after consultation across disciplines. So far, ECMO has been used to treat 5 individuals successfully. Before TBCB, the typical patient required invasive ventilation for 24 days. Only one section required TBCB, and afterward, a swab or Watanabe spigot was used to prevent any potential leakage. The significance of histology findings in informing subsequent therapy choices was examined. 5 cases of diffuse alveolar damage were identified by histology, along with one case of acute fibrinoid organizing pneumonia, one case of cryptogenic organizing pneumonia, and one case of lung cancer.
All of the findings were taken into account when making managerial decisions. Even though no pneumothoraces or major endobronchial hemorrhage occurred, 2 delayed hemothorax did necessitate surgical intervention. When it comes to TBCB, nobody has ever died. In ARDS, TBCB is doable even when on ECMO. The therapeutic and ethical considerations from histologic findings can substantially impact patient care. Adverse reactions need to be thought about and tracked.
Source: bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-022-02296-1