Abstract
BackgroundExaminations based on lung tissue specimen can play a significant role in the diagnosis for critically ill and intubated patients with lung infiltration. However, severe complications including tension pneumothorax and intrabronchial hemorrhage limit the application of needle biopsy.MethodsA refined needle biopsy technique, named bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB), was performed on four intubated patients between August 2020 and April 2021. BUS-PTNB was done at bedside, following an EPUBNOW (evaluation, preparation, ultrasound location, bronchus blocking, needle biopsy, observation, and withdrawal of blocker) workflow. Parameters including procedure feasibility, sample acquisition, perioperative conditions, and complications were observed. Tissue specimens were sent to pathological examinations and microbial tests.ResultsAdequate specimens were successfully obtained from four patients. Diagnosis and treatment were correspondingly refined based on pathological and microbial tests. Intrabronchial hemorrhage occurred in patient 1 but was stopped by endobronchial blocker. Mild pneumothorax happened in patient 4 due to little air leakage, and closed thoracic drainage was placed. During the procedure, peripheral capillary hemoglobin oxygen saturation (SPO2), blood pressure, and heart rate of patient 4 fluctuated but recovered quickly. Vital signs were stable for patient 1–3.ConclusionsBUS-PTNB provides a promising, practical and feasible method in acquiring tissue specimen for critically ill patients under intratracheal intubation. It may facilitate the pathological diagnosis or other tissue-based tests for intubated patients and improve clinical outcomes.
Highlights
Despite strong life support that modern intensive care may provide, rapid identification of etiology for patientand cause-specific treatment is vital for patients in a critical condition, especially those on invasive ventilation via endotracheal intubation [1,2,3]
A tissue-based microbial next-generation sequencing (mNGS) result may be more representative and accurate than that based on sputum, lower airway suctions, and bronchoalveolar lavage fluid (BALF) in revealing the pathogens of intended lesions [4, 5]
Cryobiopsy performed on severe patients has been reported to contain excessive bronchial tissues and the peripheral regions seem inaccessible to a bronchoscope [8].Transbronchial lung biopsy (TBLB) to obtain lung tissue is difficult in severe cases, due to high risks of bleeding and tension pneumothorax under positive pressure ventilation
Summary
Despite strong life support that modern intensive care may provide, rapid identification of etiology for patientand cause-specific treatment is vital for patients in a critical condition, especially those on invasive ventilation via endotracheal intubation [1,2,3]. Open lung biopsy for confirming a pathological diagnosis of a severe patient is relatively traumatic, difficult to implement, and risk-taking [6, 7]. Cryobiopsy performed on severe patients has been reported to contain excessive bronchial tissues and the peripheral regions seem inaccessible to a bronchoscope [8].Transbronchial lung biopsy (TBLB) to obtain lung tissue is difficult in severe cases, due to high risks of bleeding and tension pneumothorax under positive pressure ventilation. Percutaneous transthoracic needle biopsy (PTNB) is known for obtaining satisfactory peripheral lung tissues, but the risks for pneumothorax and massive intrabronchial bleeding are even higher [11]. Examinations based on lung tissue specimen can play a significant role in the diagnosis for critically ill and intubated patients with lung infiltration. Severe complications including tension pneumothorax and intrabronchial hemorrhage limit the application of needle biopsy
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