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Pascal Thomas - One of the best experts on this subject based on the ideXlab platform.
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A contributive result of Open-Lung Biopsy improves survival in acute respiratory distress syndrome patients.
Critical care medicine, 2007Co-Authors: Laurent Papazian, Christophe Doddoli, Bruno Chetaille, Yael Gernez, Xavier Thirion, Antoine Roch, Yannis Donati, Marilyne Bonnety, Christine Zandotti, Pascal ThomasAbstract:Objective: The impact of a contributive result of Open-Lung Biopsy on the outcome of patients with acute respiratory distress syndrome (ARDS) has not been extensively investigated. The aim of this study was therefore to determine the rate of contributive Open-Lung Biopsy and whether it improved the prognosis of ARDS patients. Design: Prospective study conducted during an 8-yr period. Setting: A 14-bed medico-surgical intensive care unit and a 12-bed medical intensive care unit from the same hospital. Patients: One hundred Open-Lung biopsies were performed in 100 patients presenting ARDS. Interventions: Open-Lung Biopsy was performed after >5 days of evolution of ARDS when there was no improvement in the respiratory status despite negative microbiological samples cultures and potential indication for corticosteroid treatment. Measurements and Main Results: Ten patients presented a mechanical complication following Open-Lung Biopsy (two pneumothoraces and eight moderate air leaks). The unique independent factor associated with this complication was the minute ventilation when Open-Lung Biopsy was performed (odds ratio, 1.20; 95% confidence interval, 1.03‐1.41; p .02). Fibrosis was noted in 53 patients but was associated with an infection in 29 of these 53 patients (55%). A contributive result of Open-Lung Biopsy (defined as the addition of a new drug) was noted in 78 patients. Simplified Acute Physiology Score II was the only independent predictive factor of a contributive Open-Lung Biopsy (odds ratio, 0.96; 95% confidence interval, 0.92‐0.99; p .04). Survival was higher in patients with a contributive Open-Lung Biopsy (67%) than in patients in whom Open-Lung Biopsy results did not modify the treatment (14%) (p < .001). The factors predicting survival were a contributive result of Open-Lung Biopsy, female gender, and the Organ System Failures score the day of Open-Lung Biopsy. Conclusions: The present study shows that Open-Lung Biopsy provided a contributive result in 78% of ARDS patients with a negative bronchoalveolar lavage. Survival of ARDS patients improved when Open-Lung Biopsy was contributive. (Crit Care Med 2007; 35:755‐762)
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Open-Lung Biopsy in patients with acute respiratory distress syndrome.
Anesthesiology, 1998Co-Authors: Laurent Papazian, Christine Zandotti, Pascal Thomas, Fabienne Bregeon, Louise Garbe, Pierre Saux, Françoise Gaillat, Michel Drancourt, Jean-pierre Auffray, F. GouinAbstract:Background: It has been suggested that fibrosis present during the fibroproliferative phase of acute respiratory distress syndrome (ARDS) can be treated by corticosteroids. However, neither clinical nor microbiologic criteria permit differentiation of this fibroproliferative phase from a nosocomial pneumonia. The aim of this observational case series was to evaluate the safety and utility of Open-Lung Biopsy (OLB) performed in patients receiving ventilatory support who had persistent ARDS despite negative bacterial cultures. Methods: During a 4-yr period, 37 OLBs were performed in 36 of 197 patients receiving ventilatory support who had ARDS. The severity of ARDS was assessed by a Lung injury score of 3.1 ± 0.4 (mean ± SD) and a median ratio of the partial pressure of oxygen (Pa o2 ) to the fraction of inspired oxygen (FiO 2 ) of 118 mmHg. Histologic examination; bacterial, fungal, and acid-fast staining; and cultures of the tissue sample were performed. Results: Fibrosis was present in only 41% of the Lung specimens obtained by OLB. Only six patients received corticosteroids (17%). In 9 of the 15 patients with fibrosis, cytomegalovirus pneumonia precluded the use of corticosteroids. Histologic cytomegalovirus pneumonia was diagnosed in 18 cases. Histologic bacterial or mycobacterial pneumonia was diagnosed in five cases. No significant change in arterial blood gases was noted as linked to the Biopsy procedure except an increase of the Pa o2 /FiO 2 ratio. One pneumothorax was diagnosed on a chest roentgenogram 12 h after OLB. Only one patient required blood transfusion during the 48-h period after OLB (for an hemothorax). Five patients had moderate air leaks from operative chest tubes for 2-10 days. Conclusions: Open Lung Biopsy appeared to be a useful and acceptably safe diagnostic technique in patients with ARDS. It permitted the diagnosis of unexpected cytomegalovirus pneumonia.
Laurent Papazian - One of the best experts on this subject based on the ideXlab platform.
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A contributive result of Open-Lung Biopsy improves survival in acute respiratory distress syndrome patients.
Critical care medicine, 2007Co-Authors: Laurent Papazian, Christophe Doddoli, Bruno Chetaille, Yael Gernez, Xavier Thirion, Antoine Roch, Yannis Donati, Marilyne Bonnety, Christine Zandotti, Pascal ThomasAbstract:Objective: The impact of a contributive result of Open-Lung Biopsy on the outcome of patients with acute respiratory distress syndrome (ARDS) has not been extensively investigated. The aim of this study was therefore to determine the rate of contributive Open-Lung Biopsy and whether it improved the prognosis of ARDS patients. Design: Prospective study conducted during an 8-yr period. Setting: A 14-bed medico-surgical intensive care unit and a 12-bed medical intensive care unit from the same hospital. Patients: One hundred Open-Lung biopsies were performed in 100 patients presenting ARDS. Interventions: Open-Lung Biopsy was performed after >5 days of evolution of ARDS when there was no improvement in the respiratory status despite negative microbiological samples cultures and potential indication for corticosteroid treatment. Measurements and Main Results: Ten patients presented a mechanical complication following Open-Lung Biopsy (two pneumothoraces and eight moderate air leaks). The unique independent factor associated with this complication was the minute ventilation when Open-Lung Biopsy was performed (odds ratio, 1.20; 95% confidence interval, 1.03‐1.41; p .02). Fibrosis was noted in 53 patients but was associated with an infection in 29 of these 53 patients (55%). A contributive result of Open-Lung Biopsy (defined as the addition of a new drug) was noted in 78 patients. Simplified Acute Physiology Score II was the only independent predictive factor of a contributive Open-Lung Biopsy (odds ratio, 0.96; 95% confidence interval, 0.92‐0.99; p .04). Survival was higher in patients with a contributive Open-Lung Biopsy (67%) than in patients in whom Open-Lung Biopsy results did not modify the treatment (14%) (p < .001). The factors predicting survival were a contributive result of Open-Lung Biopsy, female gender, and the Organ System Failures score the day of Open-Lung Biopsy. Conclusions: The present study shows that Open-Lung Biopsy provided a contributive result in 78% of ARDS patients with a negative bronchoalveolar lavage. Survival of ARDS patients improved when Open-Lung Biopsy was contributive. (Crit Care Med 2007; 35:755‐762)
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Open-Lung Biopsy in patients with acute respiratory distress syndrome.
Anesthesiology, 1998Co-Authors: Laurent Papazian, Christine Zandotti, Pascal Thomas, Fabienne Bregeon, Louise Garbe, Pierre Saux, Françoise Gaillat, Michel Drancourt, Jean-pierre Auffray, F. GouinAbstract:Background: It has been suggested that fibrosis present during the fibroproliferative phase of acute respiratory distress syndrome (ARDS) can be treated by corticosteroids. However, neither clinical nor microbiologic criteria permit differentiation of this fibroproliferative phase from a nosocomial pneumonia. The aim of this observational case series was to evaluate the safety and utility of Open-Lung Biopsy (OLB) performed in patients receiving ventilatory support who had persistent ARDS despite negative bacterial cultures. Methods: During a 4-yr period, 37 OLBs were performed in 36 of 197 patients receiving ventilatory support who had ARDS. The severity of ARDS was assessed by a Lung injury score of 3.1 ± 0.4 (mean ± SD) and a median ratio of the partial pressure of oxygen (Pa o2 ) to the fraction of inspired oxygen (FiO 2 ) of 118 mmHg. Histologic examination; bacterial, fungal, and acid-fast staining; and cultures of the tissue sample were performed. Results: Fibrosis was present in only 41% of the Lung specimens obtained by OLB. Only six patients received corticosteroids (17%). In 9 of the 15 patients with fibrosis, cytomegalovirus pneumonia precluded the use of corticosteroids. Histologic cytomegalovirus pneumonia was diagnosed in 18 cases. Histologic bacterial or mycobacterial pneumonia was diagnosed in five cases. No significant change in arterial blood gases was noted as linked to the Biopsy procedure except an increase of the Pa o2 /FiO 2 ratio. One pneumothorax was diagnosed on a chest roentgenogram 12 h after OLB. Only one patient required blood transfusion during the 48-h period after OLB (for an hemothorax). Five patients had moderate air leaks from operative chest tubes for 2-10 days. Conclusions: Open Lung Biopsy appeared to be a useful and acceptably safe diagnostic technique in patients with ARDS. It permitted the diagnosis of unexpected cytomegalovirus pneumonia.
Chung-chi Huang - One of the best experts on this subject based on the ideXlab platform.
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Demographics and clinical characteristics of with DAD and without DAD in ARDS patients undergoing Open Lung Biopsy.
2017Co-Authors: Kuo-chin Kao, Chih-hao Chang, Chen-yiu Hung, Li-chung Chiu, Chung-chi HuangAbstract:Demographics and clinical characteristics of with DAD and without DAD in ARDS patients undergoing Open Lung Biopsy.
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diffuse alveolar damage associated mortality in selected acute respiratory distress syndrome patients with Open Lung Biopsy
Critical Care, 2015Co-Authors: Kuo-chin Kao, Ning-hung Chen, Chih-hao Chang, Chen-yiu Hung, Li-chung Chiu, Shihwei Lin, Lipang Chuang, Chihwei Wang, Chengta Yang, Chung-chi HuangAbstract:Introduction Diffuse alveolar damage (DAD) is the pathological hallmark of acute respiratory distress syndrome (ARDS), however, the presence of DAD in the clinical criteria of ARDS patients by Berlin definition is little known. This study is designed to investigate the role of DAD in ARDS patients who underwent Open Lung Biopsy.
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Open Lung Biopsy in early-stage acute respiratory distress syndrome
Critical care (London England), 2006Co-Authors: Kuo-chin Kao, Ying-huang Tsai, Ning-hung Chen, Meng-jer Hsieh, Shiu-feng Huang, Chung-chi HuangAbstract:Introduction Acute respiratory distress syndrome (ARDS) has heterogeneous etiologies, rapid progressive change and a high mortality rate. To improve the outcome of ARDS, accurate diagnosis is essential to the application of effective early treatment. The present study investigated the clinical effects and safety of Open Lung Biopsy (OLB) in patients with early-stage ARDS of suspected non-infectious origin.
Christine Zandotti - One of the best experts on this subject based on the ideXlab platform.
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A contributive result of Open-Lung Biopsy improves survival in acute respiratory distress syndrome patients.
Critical care medicine, 2007Co-Authors: Laurent Papazian, Christophe Doddoli, Bruno Chetaille, Yael Gernez, Xavier Thirion, Antoine Roch, Yannis Donati, Marilyne Bonnety, Christine Zandotti, Pascal ThomasAbstract:Objective: The impact of a contributive result of Open-Lung Biopsy on the outcome of patients with acute respiratory distress syndrome (ARDS) has not been extensively investigated. The aim of this study was therefore to determine the rate of contributive Open-Lung Biopsy and whether it improved the prognosis of ARDS patients. Design: Prospective study conducted during an 8-yr period. Setting: A 14-bed medico-surgical intensive care unit and a 12-bed medical intensive care unit from the same hospital. Patients: One hundred Open-Lung biopsies were performed in 100 patients presenting ARDS. Interventions: Open-Lung Biopsy was performed after >5 days of evolution of ARDS when there was no improvement in the respiratory status despite negative microbiological samples cultures and potential indication for corticosteroid treatment. Measurements and Main Results: Ten patients presented a mechanical complication following Open-Lung Biopsy (two pneumothoraces and eight moderate air leaks). The unique independent factor associated with this complication was the minute ventilation when Open-Lung Biopsy was performed (odds ratio, 1.20; 95% confidence interval, 1.03‐1.41; p .02). Fibrosis was noted in 53 patients but was associated with an infection in 29 of these 53 patients (55%). A contributive result of Open-Lung Biopsy (defined as the addition of a new drug) was noted in 78 patients. Simplified Acute Physiology Score II was the only independent predictive factor of a contributive Open-Lung Biopsy (odds ratio, 0.96; 95% confidence interval, 0.92‐0.99; p .04). Survival was higher in patients with a contributive Open-Lung Biopsy (67%) than in patients in whom Open-Lung Biopsy results did not modify the treatment (14%) (p < .001). The factors predicting survival were a contributive result of Open-Lung Biopsy, female gender, and the Organ System Failures score the day of Open-Lung Biopsy. Conclusions: The present study shows that Open-Lung Biopsy provided a contributive result in 78% of ARDS patients with a negative bronchoalveolar lavage. Survival of ARDS patients improved when Open-Lung Biopsy was contributive. (Crit Care Med 2007; 35:755‐762)
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Open-Lung Biopsy in patients with acute respiratory distress syndrome.
Anesthesiology, 1998Co-Authors: Laurent Papazian, Christine Zandotti, Pascal Thomas, Fabienne Bregeon, Louise Garbe, Pierre Saux, Françoise Gaillat, Michel Drancourt, Jean-pierre Auffray, F. GouinAbstract:Background: It has been suggested that fibrosis present during the fibroproliferative phase of acute respiratory distress syndrome (ARDS) can be treated by corticosteroids. However, neither clinical nor microbiologic criteria permit differentiation of this fibroproliferative phase from a nosocomial pneumonia. The aim of this observational case series was to evaluate the safety and utility of Open-Lung Biopsy (OLB) performed in patients receiving ventilatory support who had persistent ARDS despite negative bacterial cultures. Methods: During a 4-yr period, 37 OLBs were performed in 36 of 197 patients receiving ventilatory support who had ARDS. The severity of ARDS was assessed by a Lung injury score of 3.1 ± 0.4 (mean ± SD) and a median ratio of the partial pressure of oxygen (Pa o2 ) to the fraction of inspired oxygen (FiO 2 ) of 118 mmHg. Histologic examination; bacterial, fungal, and acid-fast staining; and cultures of the tissue sample were performed. Results: Fibrosis was present in only 41% of the Lung specimens obtained by OLB. Only six patients received corticosteroids (17%). In 9 of the 15 patients with fibrosis, cytomegalovirus pneumonia precluded the use of corticosteroids. Histologic cytomegalovirus pneumonia was diagnosed in 18 cases. Histologic bacterial or mycobacterial pneumonia was diagnosed in five cases. No significant change in arterial blood gases was noted as linked to the Biopsy procedure except an increase of the Pa o2 /FiO 2 ratio. One pneumothorax was diagnosed on a chest roentgenogram 12 h after OLB. Only one patient required blood transfusion during the 48-h period after OLB (for an hemothorax). Five patients had moderate air leaks from operative chest tubes for 2-10 days. Conclusions: Open Lung Biopsy appeared to be a useful and acceptably safe diagnostic technique in patients with ARDS. It permitted the diagnosis of unexpected cytomegalovirus pneumonia.
F. Gouin - One of the best experts on this subject based on the ideXlab platform.
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Open-Lung Biopsy in patients with acute respiratory distress syndrome.
Anesthesiology, 1998Co-Authors: Laurent Papazian, Christine Zandotti, Pascal Thomas, Fabienne Bregeon, Louise Garbe, Pierre Saux, Françoise Gaillat, Michel Drancourt, Jean-pierre Auffray, F. GouinAbstract:Background: It has been suggested that fibrosis present during the fibroproliferative phase of acute respiratory distress syndrome (ARDS) can be treated by corticosteroids. However, neither clinical nor microbiologic criteria permit differentiation of this fibroproliferative phase from a nosocomial pneumonia. The aim of this observational case series was to evaluate the safety and utility of Open-Lung Biopsy (OLB) performed in patients receiving ventilatory support who had persistent ARDS despite negative bacterial cultures. Methods: During a 4-yr period, 37 OLBs were performed in 36 of 197 patients receiving ventilatory support who had ARDS. The severity of ARDS was assessed by a Lung injury score of 3.1 ± 0.4 (mean ± SD) and a median ratio of the partial pressure of oxygen (Pa o2 ) to the fraction of inspired oxygen (FiO 2 ) of 118 mmHg. Histologic examination; bacterial, fungal, and acid-fast staining; and cultures of the tissue sample were performed. Results: Fibrosis was present in only 41% of the Lung specimens obtained by OLB. Only six patients received corticosteroids (17%). In 9 of the 15 patients with fibrosis, cytomegalovirus pneumonia precluded the use of corticosteroids. Histologic cytomegalovirus pneumonia was diagnosed in 18 cases. Histologic bacterial or mycobacterial pneumonia was diagnosed in five cases. No significant change in arterial blood gases was noted as linked to the Biopsy procedure except an increase of the Pa o2 /FiO 2 ratio. One pneumothorax was diagnosed on a chest roentgenogram 12 h after OLB. Only one patient required blood transfusion during the 48-h period after OLB (for an hemothorax). Five patients had moderate air leaks from operative chest tubes for 2-10 days. Conclusions: Open Lung Biopsy appeared to be a useful and acceptably safe diagnostic technique in patients with ARDS. It permitted the diagnosis of unexpected cytomegalovirus pneumonia.
