Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China.
Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.
Crit Care. 2021 Oct 14;25(1):359. doi: 10.1186/s13054-021-03782-4.
Examinations 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.
A 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.
Adequate 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 (SPO), blood pressure, and heart rate of patient 4 fluctuated but recovered quickly. Vital signs were stable for patient 1-3.
BUS-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.
基于肺部组织标本的检查对于有肺部浸润的危重症和插管患者的诊断具有重要作用。然而，包括张力性气胸和支气管内出血在内的严重并发症限制了针吸活检的应用。
在 2020 年 8 月至 2021 年 4 月期间，对 4 名插管患者实施了一种改良的针吸活检技术，即支气管阻塞超声引导经皮经胸针吸活检（BUS-PTNB）。该技术在床边进行，遵循 EPUBNOW（评估、准备、超声定位、支气管阻塞、针吸活检、观察和阻塞器撤出）工作流程。观察了包括程序可行性、样本采集、围手术期情况和并发症在内的参数。将组织标本送检进行病理检查和微生物检测。
4 名患者均成功获得了足够的标本。基于病理和微生物检测结果，对诊断和治疗进行了相应的细化。1 例患者发生支气管内出血，但通过支气管内阻塞器得到了控制。4 例患者发生轻度气胸，由于漏气较少，放置了闭式胸腔引流管。在手术过程中，4 号患者的外周毛细血管血红蛋白氧饱和度（SPO）、血压和心率出现波动，但很快恢复。1-3 号患者的生命体征稳定。
BUS-PTNB 为经气管插管的危重症患者获取组织标本提供了一种有前途、实用且可行的方法。它可能有助于对插管患者进行病理诊断或其他基于组织的检测，从而改善临床结果。
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