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. 2024 Oct;39(10):985-993.
doi: 10.1177/08850666241247145. Epub 2024 Apr 22.

Transbronchial Lung Cryobiopsies, Transbronchial Forceps Lung Biopsies, and Surgical Lung Biopsies in Mechanically Ventilated Patients with Acute Hypoxemic Respiratory Failure: A Retrospective Cohort Study

Qi Li  1 , Dominique Lafrance  1   2 , Moishe Liberman  3   4 , Charles Leduc  4   5 , Emmanuel Charbonney  1   2   4 , Polina Titova  4 , Hélène Manganas  1   4   6 , Michaël Chassé  1   2   4
Affiliations

Transbronchial Lung Cryobiopsies, Transbronchial Forceps Lung Biopsies, and Surgical Lung Biopsies in Mechanically Ventilated Patients with Acute Hypoxemic Respiratory Failure: A Retrospective Cohort Study

Qi Li et al. J Intensive Care Med. 2024 Oct.

Abstract

Importance: Lung biopsies are sometimes performed in mechanically ventilated patients with acute hypoxemic respiratory failure (AHRF) of unknown etiology to guide patient management. While surgical lung biopsies (SLB) offer high diagnostic rates, they may also cause significant complications. Transbronchial forceps lung biopsies (TBLB) are less invasive but often produce non-contributive specimens. Transbronchial lung cryobiopsies (TBLC) yield specimens of potentially better quality than TBLB, but due to their novel implementation in the intensive care unit (ICU), their accuracy and safety are still unclear.

Objectives: Our main objective was to evaluate the risk of adverse events in patients with AHRF following the three biopsy techniques. Our secondary objectives were to assess the diagnostic yield and associated modifications of patient management of each technique.

Design, settings and participants: We conducted a retrospective cohort study comparing TBLC, TBLB, and SLB in mechanically ventilated patients with AHRF.

Main outcomes and measures: The primary outcome was the proportion of patients with at least one complication, and secondary outcomes included complication rates, diagnostic yields, treatment modifications, and mortality.

Results: Of the 26 patients who underwent lung biopsies from 2018 to 2022, all TBLC and SLB patients and 60% of TBLB patients had at least one complication. TBLC patients had higher unadjusted numbers of total and severe complications, but also worse Sequential Organ Failure Assessment scores and P/F ratios. A total of 25 biopsies (25/26, 96%) provided histopathological diagnoses, 88% (22/25) of which contributed to patient management. ICU mortality was high for all modalities (63% for TBLC, 60% for TBLB and 50% for SLB).

Conclusions and relevance: All biopsy methods had high diagnostic yields and the great majority contributed to patient management; however, complication rates were elevated. Further research is needed to determine which patients may benefit from lung biopsies and to determine the best biopsy modality.

Keywords: biopsy; bronchoscopy; mechanical; respiratory insufficiency; thoracic surgery; ventilators; video-assisted.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Histological diagnoses DAD, diffuse alveolar damage; OP, organizing pneumonia; AFOP, acute fibrinous organizing pneumonia; *infectious pathogens found in specimens: aspergillus, herpes simplex virus (HSV), cytomegalovirus (CMV), pneumocystis jiroveci, Stenotrophomonas maltophilia.
Figure 2.
Figure 2.
Treatment modifications.
See this image and copyright information in PMC

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