Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec 9:2020:2909673.
doi: 10.1155/2020/2909673. eCollection 2020.

What Open-Lung Biopsy Teaches Us about ARDS in COVID-19 Patients: Mechanisms, Pathology, and Therapeutic Implications

Yassamine Abourida  1   2 , Houssam Rebahi  1   2 , Hajar Chichou  1   2 , Hicham Fenane  3 , Yassine Msougar  3 , Anas Fakhri  4 , Fatima Ezzahra Hazmiri  4 , Ayman Ismail  5 , Hanane Rais  5 , Nabila Soraa  6 , Mohammed Abdenasser Samkaoui  1
Affiliations

What Open-Lung Biopsy Teaches Us about ARDS in COVID-19 Patients: Mechanisms, Pathology, and Therapeutic Implications

Yassamine Abourida et al. Biomed Res Int. .

Abstract

Difficulties have risen while managing Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19, although it meets the Berlin definition. Severe hypoxemia with near-normal compliance was noted along with coagulopathy. Understanding the precise pathophysiology of this atypical ARDS will assist researchers and physicians in improving their therapeutic approach. Previous work is limited to postmortem studies, while our report addresses patients under protective lung mechanical ventilation. An open-lung minithoracotomy was performed in 3 patients who developed ARDS related to COVID-19 and were admitted to the intensive care unit to carry out a pathological and microbiological analysis on lung tissue biopsy. Diffused alveolar damage with hyaline membranes was found, as well as plurifocal fibrin microthrombi and vascular congestion in all patients' specimens. Microbiological cultures were negative, whereas qualitative Reversed Transcriptase Polymerase Chain Reaction (RT-PCR) detected SARS-CoV-2 in the pulmonary parenchyma and pleural fluid in two patients. COVID-19 causes progressive ARDS with onset of severe hypoxemia, underlying a dual mechanism: shunt effect through diffused alveolar damage and dead space effect through thrombotic injuries in microvascular beds. It seems reasonable to manage this ventilation-perfusion ratio mismatch using a high dose of anticoagulant combined with glucocorticoids.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interest.

Figures

Figure 1
Figure 1
Rib spreading during minithoracotomy.
Figure 2
Figure 2
Surgical team performing open-lung biopsy while wearing appropriate personal protective equipment.
Figure 3
Figure 3
Thickening of the interalveolar walls (×10 magnification) (Case 2).
Figure 4
Figure 4
Enlarged alveolar airspace demonstrating emphysema (×20 magnification) (Case 3).
Figure 5
Figure 5
Protein exudates (×40 magnification) (Case 1).
Figure 6
Figure 6
Type II pneumocytes displaying an atypical appearance with desquamation (×20 magnification) (Case 3).
Figure 7
Figure 7
Fibroblastic multinucleated giant cells (×30 magnification) (Case 3).
Figure 8
Figure 8
Hyaline membranes in the alveolar walls (×40 magnification) (Case 2).
Figure 9
Figure 9
(a) Fibrinoid microthrombi (×10 magnification) (Case 2). (b) Fibrinoid microthrombi (×10 magnification) (Case 1).
Figure 10
Figure 10
Vascular congestion (×10 magnification) (Case 2).
See this image and copyright information in PMC

References

    1. Wang D., Hu B., Hu C., et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed
    1. Gattinoni L., Coppola S., Cressoni M., Busana M., Rossi S., Chiumello D. COVID-19 does not lead to a “typical” acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine. 2020;201(10):1299–1300. doi: 10.1164/rccm.202003-0817LE. - DOI - PMC - PubMed
    1. Ashbaugh D. G., Bigelow D. B., Levine B. E. Acute respiratory distress in adults. The Lancet. 1967;290(7511):319–323. - PubMed
    1. Thompson B. T., Guérin C., Esteban A. Should ARDS be renamed diffuse alveolar damage? Intensive Care Medicine. 2016;42(5):653–655. doi: 10.1007/s00134-016-4296-5. - DOI - PubMed
    1. Puelles V. G., Lütgehetmann M., Lindenmeyer M. T., et al. Multiorgan and renal tropism of SARS-CoV-2. New England Journal of Medicine. 2020;383(6):590–592. doi: 10.1056/NEJMc2011400. - DOI - PMC - PubMed