Which patients with ARDS benefit from lung biopsy?

Area of Science:

• Pulmonology
• Critical Care Medicine
• Pathology

Background:

• Acute hypoxemic respiratory failure (ARDS) management often relies on identifying and treating the underlying cause.
• However, the precipitating factor for ARDS is frequently unclear, complicating diagnosis and treatment.
• Histologic lung diagnosis is considered in cases where the cause of ARDS remains elusive.

Purpose of the Study:

• To review the historical and current role of pathology in diagnosing ARDS.
• To evaluate the published experience and utility of surgical and transbronchial lung biopsies in ARDS patients.
• To discuss which pathological findings significantly influence clinical management and to propose a patient-centered approach for considering lung biopsy.

Main Methods:

• Literature review of the role of pathology in ARDS diagnosis.
• Analysis of published data on surgical and transbronchial lung biopsies in ARDS.
• Discussion of treatment implications based on histopathological findings.

Main Results:

• Pathology has historically played a role in defining ARDS.
• Lung biopsy data in ARDS patients is limited but provides insights into specific diagnoses.
• Certain histopathological findings can guide specific therapeutic interventions.

Conclusions:

• A histologic lung diagnosis can be beneficial when the cause of ARDS is unclear.
• A careful risk-benefit assessment is crucial before performing lung biopsies in critically ill ARDS patients.
• A patient-centric approach should guide the decision-making process for lung biopsies in ARDS.