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

Abstract

Background: Acute hypoxemic respiratory failure is common in intensive care units (ICUs). Lung biopsies may be required to make a definitive diagnosis in patients with unknown etiologies. The feasibility of transbronchial lung cryobiopsy is undetermined in patients with respiratory failure in the ICU.

Methods: Patients who underwent bronchoscopy examinations with transbronchial lung cryobiopsy (TBLC) between July 2018 and December 2019 were retrospectively analyzed through medical chart review. The procedures were performed by well-experienced interventional pulmonologists.

Results: Ten patients underwent bronchoscopy examinations with TBLC in the ICU at Chang Gung Memorial Hospital during the study period. In all patients, the diagnosis was made via pathological analysis. One patient developed pneumothorax and required chest tube placement after the procedure. None of the patients had bleeding requiring blood transfusion, and no deaths were directly related to the procedure.

Conclusions: TBLC is a feasible technique to obtain lung pathology in patients with acute respiratory diseases of unknown etiologies. While the complication rate may be acceptable, the procedure should be performed by experienced interventional pulmonologists. However, airway blockers and fluoroscopy are highly recommended when used according to the current guideline. We do not encourage TBLC to be performed without having airway blockers available at the bedside.

Keywords: ARDS; TBLC; bronchoscopy; critical care; lung.

Figure 1

(A) The transverse unenhanced chest CT image showed dependent and peribronchovascular consolidations as well as diffuse heterogeneous ground glass opacities in bilateral lungs. (B) The pathology result showed diffuse alveolar damage patterns. The alveolar walls were thickened by organizing loose connective tissue. Hyaline membranes were seen (arrow) (hematoxylin and eosin stain, 200×).

Figure 2

(A) The transverse unenhanced chest CT image showed diffuse ground glass opacities and reticulations in bilateral lungs. There were foci of air trapping in the peripheral right upper lung (arrow) and subpleural honeycombing in the left lower lung (arrowhead). (B) The lung parenchyma showed fibrosis (hematoxylin and eosin stain, 100×).