PURPOSE: The aim of the present study was to assess the rate of diffuse alveolar damage (DAD) on open lung biopsy (OLB) performed in the ICU for nonresolving ARDS. METHODS: A single-center retrospective study of patients meeting the Berlin definition criteria for ARDS who had undergone OLB for nonresolving ARDS. Patients were classified into mild, moderate and severe ARDS categories and according to the presence or absence of DAD on the OLB. The ARDS categories were assessed at baseline and at the time of the OLB. The OLBs were reviewed by two pathologists blinded to the ARDS classification. The primary endpoint was the rate of DAD according to the ARDS stage in the patients with nonresolving ARDS who had OLB. The secondary endpoint was the ability of DAD to predict ARDS among all the patients who had OLB. The same clinico-histopathological confrontation was cross validated in another ICU. RESULTS: From January 1998 to August 2013, 113 patients underwent OLB for acute hypoxemic respiratory failure, 83 of whom met the inclusion criteria for ARDS. At the time the OLB was performed, 11 of these patients had mild, 56 moderate, and 16 severe ARDS, respectively. The median (1st-3rd quartiles) time to OLB was 13 (10-18) and 9 (6-14) days from the onset of respiratory symptoms and from ARDS onset, respectively, with no statistical difference between the three ARDS groups. DAD was found in 48 (58 %) patients with ARDS, 4 (36 %) in the mild, 33 (59 %) in the moderate, and 11 (69 %) in the severe stage (P = 0.23). For the 113 patients who underwent OLB, the sensitivity and specificity of DAD to the Berlin definition was 0.58 (0.46-0.69) and 0.73 (0.54-0.88), respectively. Similar results were found in the other ICU. CONCLUSIONS: DAD is present in the majority of patients with nonresolving ARDs and its frequency is no different across the three ARDS stages. On this basis, the systematic use of steroids in nonresolving ARDS is not recommended.
PURPOSE: The aim of the present study was to assess the rate of diffuse alveolar damage (DAD) on open lung biopsy (OLB) performed in the ICU for nonresolving ARDS. METHODS: A single-center retrospective study of patients meeting the Berlin definition criteria for ARDS who had undergone OLB for nonresolving ARDS. Patients were classified into mild, moderate and severe ARDS categories and according to the presence or absence of DAD on the OLB. The ARDS categories were assessed at baseline and at the time of the OLB. The OLBs were reviewed by two pathologists blinded to the ARDS classification. The primary endpoint was the rate of DAD according to the ARDS stage in the patients with nonresolving ARDS who had OLB. The secondary endpoint was the ability of DAD to predict ARDS among all the patients who had OLB. The same clinico-histopathological confrontation was cross validated in another ICU. RESULTS: From January 1998 to August 2013, 113 patients underwent OLB for acute hypoxemic respiratory failure, 83 of whom met the inclusion criteria for ARDS. At the time the OLB was performed, 11 of these patients had mild, 56 moderate, and 16 severe ARDS, respectively. The median (1st-3rd quartiles) time to OLB was 13 (10-18) and 9 (6-14) days from the onset of respiratory symptoms and from ARDS onset, respectively, with no statistical difference between the three ARDS groups. DAD was found in 48 (58 %) patients with ARDS, 4 (36 %) in the mild, 33 (59 %) in the moderate, and 11 (69 %) in the severe stage (P = 0.23). For the 113 patients who underwent OLB, the sensitivity and specificity of DAD to the Berlin definition was 0.58 (0.46-0.69) and 0.73 (0.54-0.88), respectively. Similar results were found in the other ICU. CONCLUSIONS:DAD is present in the majority of patients with nonresolving ARDs and its frequency is no different across the three ARDS stages. On this basis, the systematic use of steroids in nonresolving ARDS is not recommended.
Authors: Andrés Esteban; Pilar Fernández-Segoviano; Fernando Frutos-Vivar; José Antonio Aramburu; Laura Nájera; Niall D Ferguson; Inmaculada Alía; Federico Gordo; Fernando Ríos Journal: Ann Intern Med Date: 2004-09-21 Impact factor: 25.391
Authors: Arnaud W Thille; Andrés Esteban; Pilar Fernández-Segoviano; José-María Rodriguez; José-Antonio Aramburu; Patricio Vargas-Errázuriz; Ana Martín-Pellicer; José A Lorente; Fernando Frutos-Vivar Journal: Lancet Respir Med Date: 2013-05-15 Impact factor: 30.700
Authors: Niall D Ferguson; Eddy Fan; Luigi Camporota; Massimo Antonelli; Antonio Anzueto; Richard Beale; Laurent Brochard; Roy Brower; Andrés Esteban; Luciano Gattinoni; Andrew Rhodes; Arthur S Slutsky; Jean-Louis Vincent; Gordon D Rubenfeld; B Taylor Thompson; V Marco Ranieri Journal: Intensive Care Med Date: 2012-08-25 Impact factor: 17.440
Authors: Aude Gibelin; Antoine Parrot; Bernard Maitre; Christian Brun-Buisson; Armand Mekontso Dessap; Muriel Fartoukh; Nicolas de Prost Journal: Intensive Care Med Date: 2015-09-25 Impact factor: 17.440
Authors: José A Lorente; Pablo Cardinal-Fernández; Diego Muñoz; Fernando Frutos-Vivar; Arnaud W Thille; Carlos Jaramillo; Aida Ballén-Barragán; José M Rodríguez; Oscar Peñuelas; Guillermo Ortiz; José Blanco; Bruno Valle Pinheiro; Nicolás Nin; María del Carmen Marin; Andrés Esteban; Taylor B Thompson Journal: Intensive Care Med Date: 2015-09-18 Impact factor: 17.440