Transbronchial Lung Cryobiopsy in an Intensive Care Unit

Perez, Ma Rosa Cordovilla; Guevara, Virginia; Rosales, Milagros; P, Susana Blanco; Pérez, Marta Paz; Cascón, Juan; Maciá, Clara Martí; Cruz, M.; Mezquita, Miguel Ángel Hernández; Ruiz, Jose Ma González

doi:10.1183/13993003.congress-2018.pa3385

Cited by 2 publications

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“…Determination of etiology of DPLD in critically ill patients could pose a significant challenge. There is limited data on the role of TBC in diagnosis of DPLD in critically ill patients in the ICU 10,11 . In this case series of 17 ICU patients who underwent TBC, histopathologic patterns of DPLD were identified in 88% of patients with acute hypoxemic respiratory failure.…”

Section: Discussionmentioning

confidence: 88%

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

Matta

Gupta

Swank

et al. 2021

Clinical Respiratory J

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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.

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Section: Discussionmentioning

confidence: 88%

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

Matta

Gupta

Swank

et al. 2021

Clinical Respiratory J

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“…Also, identifying the ideal location of the procedure means of delivering mechanical ventilation, and the experience of proceduralists may contribute to the acceptance of this invasive procedure performed on critically ill patients. There is also the potential for studying the safety and yield of cryobiopsy in this patient population as this could increase the diagnostic yield with potentially less risk than open lung biopsy 23–25…”

Section: Discussionmentioning

confidence: 99%

Transbronchial Forceps Biopsy in the Intensive Care Unit

Helgeson

Imam

Burnside³

et al. 2021

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: A transbronchial forceps lung biopsy performed in mechanically ventilated patients with respiratory failure of unknown etiology has significant uncertainty of diagnostic yield and safety along with sparse literature. This study investigated the complication rate of transbronchial biopsies in mechanically ventilated patients in the intensive care unit and its ability to obtain a diagnosis and change current therapy.Methods: PubMed, Ovid MEDLINE, and Ovid Cochrane Central Register of Controlled Trials databases were systematically searched for all publications of transbronchial lung biopsies in mechanically ventilated patients. We pooled the results of individual studies using random-effects meta-analysis models to achieve the summary proportions.Results: Of the identified 9 observational studies with a total of 232 patients undergoing a transbronchial biopsy, complications occurred in 67 patients [25.2%; 95% confidence interval (CI), 11.5%-42.0%; I 2 = 70.0%]. Pneumothorax occurred in 24 patients (9.5%; 95% CI, 4.5%-16.2%; I 2 = 15.9%) and bleeding in 18 patients (8.9%; 95% CI, 4.1%-15.3%; I 2 = 0%). A diagnosis was given in 146 patients (62.9%; 95% CI, 56.0%-69.1%; I 2 = 74.6%), with 103 of 210 patients (49.0%; 95% CI, 44.6%-55.1%; I 2 = 74.9%) having a change in treatment. Conclusion:The results of this meta-analysis suggest that a transbronchial forceps biopsy when performed in mechanically ventilated patients with respiratory failure of unclear etiology had a moderate complication rate. These biopsies resulted in varied diagnoses with a high rate of management change. Randomized controlled trials are necessary to identify the ideal patients to perform a transbronchial forceps biopsy on in the intensive care unit.

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Transbronchial Lung Cryobiopsy in an Intensive Care Unit

Cited by 2 publications

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

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

Transbronchial Forceps Biopsy in the Intensive Care Unit

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