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Erschienen in: Intensive Care Medicine 2/2015

01.02.2015 | Original

Open lung biopsy in nonresolving ARDS frequently identifies diffuse alveolar damage regardless of the severity stage and may have implications for patient management

verfasst von: Claude Guerin, Frédérique Bayle, Véronique Leray, Sophie Debord, Alina Stoian, Hodane Yonis, Jean-Baptiste Roudaut, Gael Bourdin, Mojgan Devouassoux-Shisheboran, Elodie Bucher, Louis Ayzac, Sylvie Lantuejoul, Carole Philipponnet, Jean Louis Kemeny, Bertrand Souweine, Jean-Christophe Richard

Erschienen in: Intensive Care Medicine | Ausgabe 2/2015

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Abstract

Purpose

The aim of the present study was to assess the rate of diffuse alveolar damage (DAD) on open lung biopsy (OLB) performed in the ICU for nonresolving ARDS.

Methods

A single-center retrospective study of patients meeting the Berlin definition criteria for ARDS who had undergone OLB for nonresolving ARDS. Patients were classified into mild, moderate and severe ARDS categories and according to the presence or absence of DAD on the OLB. The ARDS categories were assessed at baseline and at the time of the OLB. The OLBs were reviewed by two pathologists blinded to the ARDS classification. The primary endpoint was the rate of DAD according to the ARDS stage in the patients with nonresolving ARDS who had OLB. The secondary endpoint was the ability of DAD to predict ARDS among all the patients who had OLB. The same clinico-histopathological confrontation was cross validated in another ICU.

Results

From January 1998 to August 2013, 113 patients underwent OLB for acute hypoxemic respiratory failure, 83 of whom met the inclusion criteria for ARDS. At the time the OLB was performed, 11 of these patients had mild, 56 moderate, and 16 severe ARDS, respectively. The median (1st–3rd quartiles) time to OLB was 13 (10–18) and 9 (6–14) days from the onset of respiratory symptoms and from ARDS onset, respectively, with no statistical difference between the three ARDS groups. DAD was found in 48 (58 %) patients with ARDS, 4 (36 %) in the mild, 33 (59 %) in the moderate, and 11 (69 %) in the severe stage (P = 0.23). For the 113 patients who underwent OLB, the sensitivity and specificity of DAD to the Berlin definition was 0.58 (0.46–0.69) and 0.73 (0.54–0.88), respectively. Similar results were found in the other ICU.

Conclusions

DAD is present in the majority of patients with nonresolving ARDs and its frequency is no different across the three ARDS stages. On this basis, the systematic use of steroids in nonresolving ARDS is not recommended.
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Metadaten
Titel
Open lung biopsy in nonresolving ARDS frequently identifies diffuse alveolar damage regardless of the severity stage and may have implications for patient management
verfasst von
Claude Guerin
Frédérique Bayle
Véronique Leray
Sophie Debord
Alina Stoian
Hodane Yonis
Jean-Baptiste Roudaut
Gael Bourdin
Mojgan Devouassoux-Shisheboran
Elodie Bucher
Louis Ayzac
Sylvie Lantuejoul
Carole Philipponnet
Jean Louis Kemeny
Bertrand Souweine
Jean-Christophe Richard
Publikationsdatum
01.02.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 2/2015
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-014-3583-2

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