The use of transbronchial cryobiopsy for diffuse parenchymal lung disease in critically ill patients with acute hypoxemic respiratory failure—A case series

Abstract

Objectives: Accurate diagnosis and management of undifferentiated diffuse parenchymal lung disease (DPLD) in critically ill patients is challenging. Transbronchial forceps biopsies have limited utility and surgical lung biopsies can be detrimental for critically ill patients. Transbronchial cryobiopsy (TBC) has shown increased diagnostic yield compared to conventional forceps biopsy in DPLD. However, TBC has not been studied in intensive care unit (ICU) patients. In this case series, we describe our experience with TBC for diagnosis of DPLD in ICU patients with acute hypoxemic respiratory failure. Methods: This case series includes critically ill patients who underwent TBC at two different tertiary care hospitals. Procedures were performed by the same interventional pulmonologist using the two therapeutic bronchoscopes with a 2.8-mm working channel, and a 1.9-or 2.4-mm cryoprobe. Results: We performed TBC in 17 patients of which 12 (70.1%) were performed at bedside in ICU without fluoroscopic guidance. Pathological diagnosis was made in 15 (88%) patients which resulted in changes in management in most of these patients.Six patients (35.3%) developed pneumothorax post-procedure with 5 (29.4%) requiring a chest tube. Moderate bleeding was noted in one (6%) patient and no severe or fatal bleeding occurred. Our 30-day ICU mortality was 47% (n = 8); however, no deaths were directly attributable to the procedure. Conclusions: TBC is a feasible technique with an acceptable complication rate and a fairly high histopathological yield in ICU patients with DPLD and acute hypoxemic respiratory failure. Appropriate diagnosis can be crucial in making management decisions for these patients.

Feasibility of transbronchial lung cryobiopsy in patients with veno-venous extracorporeal membrane oxygenation support

“…It is worth mentioning that although all patients in this study were initially thought to have non-infectious diseases, some patients were found to have viral pneumonia. Previous studies have found similar results, regardless of the method of biopsy [3,4,25,[27][28][29]. In addition, it is also notable that four patients in our study had TBLC indicating a fibrotic phase of DAD, including two patients with a combined proliferative phase of DAD, but none of these four patients survived.…”

Transbronchial lung cryobiopsy for the diagnosis of interstitial lung diseases

“…However, some authors reported the use of two bronchoscopes: one bronchoscope for the cryoprobe and one bronchoscope wedged at the bronchus to control bleeding [17][18][19]; no complications have been described and diagnostic yield was good. A cryoprobe (2.4, 1.9 or 1.7 mm in diameter) is introduced into the lung under fluoroscopic guidance through the working channel of a flexible bronchoscope.…”

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

“…Furthermore, treatment adjustment rates in patients who underwent TBLC were also higher than in those who underwent TBLB. Matta et al performed TBLC for diffuse parenchymal lung disease at the bedside of patients with acute hypoxemic respiratory failure without fluoroscopic guidance at two tertiary hospitals [ 34 ]. After pathological diagnosis made by TBLC, 88% of patients had treatment adjustments.…”