Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: Improved Outcome with specific diagnosis

Zihlif, Mamoon; Khanchandani, Geeta; Ahmed, Huma; Soubani, Ayman O.

doi:10.1002/ajh.20258

Cited by 56 publications

(51 citation statements)

References 28 publications

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“…This finding is consistent with those of previous reports and emphasizes the usefulness of surgical OLBs in worsening ARDS [11,13,14,23,24]. We observed a very high mortality rate (89%), due to multiple organ disorders of the patients and the severity of their organic damage.…”

Section: Discussionsupporting

confidence: 93%

“…This has already been previously suggested by several series, including in immunocompromised patients in whom empirical treatment of all potential etiologies may be detrimental [11][12][13][14]17] and in early-stage ARDS of suspected noninfectious origin [18]. In addition, despite many theoretical advantages and encouraging preliminary reports, transbronchial biopsies may not represent a good alternative to surgical OLB in severely ill ventilated ARDS patients [19][20][21].…”

Section: Discussionmentioning

confidence: 96%

“…Hence, surgical biopsy is a recognized accurate diagnostic method for diffuse lung disease in immunocompetent patients [10]. In patients with respiratory distress, many authors suggest that surgical open lung biopsies (OLBs) can be performed safely with a high diagnosis yield [11,12], even if the they have hematologic diseases [13]. Papazian et al [14] reported in 1998 a very low rate of complications and suggested that such procedure may be performed at the bedside.…”

Section: Introductionmentioning

confidence: 99%

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Impact of bedside open lung biopsies on the management of mechanically ventilated immunocompromised patients with acute respiratory distress syndrome of unknown etiology

Charbonney

Robert

Pache

et al. 2009

Journal of Critical Care

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Background: Open lung biopsy (OLB) is helpful in the management of patients with acute respiratory distress syndrome (ARDS) of unknown etiology. We determine the impact of surgical lung biopsies performed at the bedside on the management of patients with ARDS. Methods: We reviewed all consecutive cases of patients with ARDS who underwent a surgical OLB at the bedside in a medical intensive care unit between 1993 and 2005. Results: Biopsies were performed in 19 patients mechanically ventilated for ARDS of unknown etiology despite extensive diagnostic process and empirical therapeutic trials. Among them, 17 (89%) were immunocompromised and 10 patients experienced hematological malignancies. Surgical biopsies were obtained after a median (25%-75%) mechanical ventilation of 5 (2-11) days; mean (±SD) PaO 2 / FiO 2 ratio was 119.3 (±34.2) mm Hg. Histologic diagnoses were obtained in all cases and were specific in 13 patients (68%), including 9 (47%) not previously suspected. Immediate complications (26%) were local (pneumothorax, minimal bleeding) without general or respiratory consequences. The biopsy resulted in major changes in management in 17 patients (89%). It contributed to a decision to limit care in 12 of 17 patients who died. Conclusion: Our data confirm that surgical OLB may have an important impact on the management of patients with ARDS of unknown etiology after extensive diagnostic process. The procedure can be performed at the bedside, is safe, and has a high diagnostic yield leading to major changes in management, including withdrawal of vital support, in the majority of patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Impact of bedside open lung biopsies on the management of mechanically ventilated immunocompromised patients with acute respiratory distress syndrome of unknown etiology

Charbonney

Robert

Pache

et al. 2009

Journal of Critical Care

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“…CMV, cytomegalovirus. practice the number of patients submitted to flexible bronchoscopy prior OLB may be less than expected (43)(44)(45)(46). Some of the potential explanations include lesions localization, conditions that could increase the risk of complications such as high levels of positive end-expiratory pressure, risk of bleeding, and pulmonary hypertension, and the general believe in the low diagnostic yield of the procedure (43).…”

Section: Discussionmentioning

confidence: 99%

The diagnostic yield and complications of open lung biopsies in kidney transplant patients with pulmonary disease

et al. 2017

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Background: The purpose of this study was to assess the efficacy of open lung biopsy (OLB) in determining the specific diagnosis and the related complications in patients with undiagnosed diffuse pulmonary infiltrates.Methods: This single center, retrospective study included adult kidney transplant patients who underwent OLB. The patients had diffuse pulmonary infiltrates without definitive diagnoses and failed to respond to empiric antibiotic treatment. We analyzed the number of specific diagnoses, changes in treatment and the occurrence of complications in these patients. A logistic regression was used to determine which variables were predictors of hospital mortality. Results: From April 2010 to April 2014, 87 patients consecutively underwent OLB. A specific diagnosis was reached in 74 (85.1%) patients. In 46 patients (53%), their therapeutic management was changed after the OLB results. Twenty-five (28.7%) patients had complications related to the OLB. The hospital mortality rate was 25.2%. Age, SAPS3 score and complications related to the procedure were independent predictors of all-cause mortality. Conclusions: OLB is a high-risk procedure with a high diagnostic yield in kidney transplant patients with diffuse pulmonary infiltrates who did not have a definitive diagnosis and who failed to respond to empiric antibiotic treatment. Complications related to OLB were common and were independently associated with intra-hospital mortality.

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“…However, commonly, this procedure is limited by the relatively high surgical morbidity and mortality rates in this patient population. 72 Chellapandian and associates recently compared the diagnostic yield of BAL with that of lung biopsy. 73 Although yield was similar for both procedures, BAL diagnosed more infectious causes, whereas lung biopsies led to more noninfectious ones.…”

Section: Viral Pneumoniamentioning

confidence: 99%

Untitled

Diab

ZazaDitYafawi

Soubani³

2016

Exp Clin Transplant

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Both autologous and allogeneic hematopoietic stem cell transplants are important therapeutic options for several benign and malignant disorders. Pulmonary complications, although they have become less frequent, remain a significant cause of morbidity and mortality after hematopoietic stem cell transplant. These complications range from bacterial, fungal, and viral pulmonary infections to noninfectious conditions such as diffuse alveolar hemorrhage and idiopathic pneumonia syndrome. Bronchiolitis obliterans syndrome is the primary chronic pulmonary complication, and treatment of this condition remains challenging. This report highlights the advances in the diagnosis and management of the major pulmonary complications after hematopoietic stem cell transplant. It also underscores the need for prospective and multicenter research to have a better understanding of the mechanisms behind these complications and to obtain more effective diagnostic tool and therapeutic options. Key words: Adverse effects, Lung diseases/etiology, Lung diseases/diagnosis, Respiratory tract infections/etiology, Graft versus host disease IntroductionHematopoietic stem cell transplant (HSCT) is increasingly being used for treatment of a wide range of benign and malignant diseases. About 50 000 to 60 000 HSCTs are done annually. 1 Hematopoietic stem cell transplant can be classified as autologous when the stem cells are harvested from the same patient and reinfused after high-dose chemotherapy, whereas, in allogeneic HSCT, the stem cells are donated by another person. Allogeneic HSCT can be related or unrelated and matched or mismatched. The hematopoietic stem cells might be derived from the bone marrow, umbilical cord, or peripheral blood.Hematopoietic stem cell transplant can be a lifesaving treatment of a wide range of neoplastic and nonneoplastic diseases; however, it is still limited by the development of serious complications. Advances in the preparative regimen using a nonmyeloablative preparative regimen, reduced-intensity conditioning transplants, and posttransplant supportive care have contributed to improved overall survival. Despite these advances, pulmonary complications still occur in about 37% of patient after HSCT 2 and are associated with significant morbidity and mortality. In 1 study, the hazard ratio for death due to pulmonary complications was 30. 1 However, there is evidence that the overall mortality and pulmonary complications after HSCT are improving. A recent review of allogeneic HSCT patients in a large transplant center from 1993 to 2007 showed that the risk of nonrelapse mortality decreased by 60% and overall mortality decreased by 41%. In addition, the risk of acute respiratory failure dropped by 36%, with risk of gram-negative bacterial and invasive mold infections decreasing by 39% and 51%. 3 In this study, we provide an update of the main pulmonary complications (both infectious and noninfectious) after HSCT, including an overview of the diagnostic approach and treatment of these complications. Noninfec...

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Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: Improved Outcome with specific diagnosis

Cited by 56 publications

References 28 publications

Impact of bedside open lung biopsies on the management of mechanically ventilated immunocompromised patients with acute respiratory distress syndrome of unknown etiology

Impact of bedside open lung biopsies on the management of mechanically ventilated immunocompromised patients with acute respiratory distress syndrome of unknown etiology

The diagnostic yield and complications of open lung biopsies in kidney transplant patients with pulmonary disease

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