Cryobiopsy in ARDS
Cryobiopsy in ARDS
Cryobiopsy in ARDS
in acute respiratory
distress syndrome
with unknown
etiology
張志豪醫師
林口長庚醫院/土城醫院
胸腔內科
2020-06-20
Outline
1. Heterogeneity of ARDS
ARDS
我的ARDS
Lancet Respir Med 2020;8: 420–22
Pathology in COVID-19 ARDS
JAMA. 2012;307(23):2526-2533
“Imitators” of the ARDS
The prevalence of
ARDSCRF- was
7.5 %
immune(36 %),
drug-induced (26 %),
malignant (14 %),
idiopathic (24 %).
JAMA. 2016;315(8):788-800.
ARDS without common risk factors
Am J Respir Crit Care Med Vol 187, Iss. 7, pp 761–767, Apr 1, 2013
. The proportion of DAD significantly increased with the
severity of ARDS
Pathologic Criteria for DAD
Am J Respir Crit Care Med Vol 187, Iss. 7, pp 761–767, Apr 1, 2013
Open lung biopsy in ARDS (meta-analysis)
Cryobiopsy
Observation Surgical
TBLB
biopsy
Case 1
66 y/o M 2018/12 CXR
BiPAP at ICU
Case 2
62 M 2018/8 CXR
The patient was transferred from 桃分
2.出院診斷(Diagnosis on Discharge):
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1. Hypoxemia respiratory failure s/p intubation with
ventilator support on 8/13, bilateral pneumonia
related
2. Acute respiratory distress syndrome
3. Bilateral pneumonia, suspect necrotizing
pneumonitis
4. Septic shock
5. Right lung mass
Case 3
Case presentationˊ
Fungus culture
1 Aspergillus fumigatus Rare -
2 Aspergillus flavus Rare -
Virus culture
Virus HSV-1
Final diagnosis
1. ARDS
2. Pneumonia due to aspergillus and herpes virus
infection
Thank you for
Thanks for your attention
your attention