Abstract：
OBJECTIVE: 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.
OBJECTIVE: 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.
METHODS: We conducted a retrospective cohort study comparing TBLC, TBLB, and SLB in mechanically ventilated patients with AHRF.
METHODS: 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: 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.
OBJECTIVE: 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.
METHODS: We conducted a retrospective cohort study comparing TBLC, TBLB, and SLB in mechanically ventilated patients with AHRF.
METHODS: 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: 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.
摘要：
目的：有时会对病因不明的急性低氧性呼吸衰竭（AHRF）机械通气患者进行肺活检，以指导患者治疗。虽然外科肺活检（SLB）提供高诊断率，它们也可能导致严重的并发症。经支气管镊子肺活检（TBLB）的侵入性较小，但通常会产生无贡献的标本。经支气管肺冷冻活检（TBLC）产生的标本质量可能优于TBLB，但是由于它们在重症监护病房（ICU）的新颖实施，其准确性和安全性仍不清楚。
目的：我们的主要目的是评估使用三种活检技术后AHRF患者发生不良事件的风险。我们的次要目标是评估每种技术的诊断率和患者管理的相关修改。
方法：我们进行了一项回顾性队列研究，比较了TBLC，TBLB,和SLB在机械通气的AHRF患者中的应用。
方法：主要结果是至少有一种并发症的患者比例，次要结果包括并发症发生率，诊断产量，治疗修改，和死亡率。
结果：在2018年至2022年接受肺活检的26例患者中，所有TBLC和SLB患者以及60％的TBLB患者至少有一种并发症。TBLC患者的总并发症和严重并发症的未调整数量较高，但更差的序贯器官衰竭评估评分和P/F比。共有25个活检（25/26，96％）提供了组织病理学诊断，其中88%（22/25）有助于患者管理。所有模式的ICU死亡率都很高(TBLC为63%，TBLB为60%，SLB为50%）。
结论：所有活检方法都有很高的诊断率，而且绝大多数方法都有助于患者管理；然而，并发症发生率升高。需要进一步的研究来确定哪些患者可以从肺活检中受益，并确定最佳的活检方式。
目的：我们的主要目的是评估使用三种活检技术后AHRF患者发生不良事件的风险。我们的次要目标是评估每种技术的诊断率和患者管理的相关修改。
方法：我们进行了一项回顾性队列研究，比较了TBLC，TBLB,和SLB在机械通气的AHRF患者中的应用。
方法：主要结果是至少有一种并发症的患者比例，次要结果包括并发症发生率，诊断产量，治疗修改，和死亡率。
结果：在2018年至2022年接受肺活检的26例患者中，所有TBLC和SLB患者以及60％的TBLB患者至少有一种并发症。TBLC患者的总并发症和严重并发症的未调整数量较高，但更差的序贯器官衰竭评估评分和P/F比。共有25个活检（25/26，96％）提供了组织病理学诊断，其中88%（22/25）有助于患者管理。所有模式的ICU死亡率都很高(TBLC为63%，TBLB为60%，SLB为50%）。
结论：所有活检方法都有很高的诊断率，而且绝大多数方法都有助于患者管理；然而，并发症发生率升高。需要进一步的研究来确定哪些患者可以从肺活检中受益，并确定最佳的活检方式。
