Chest
Volume 107, Issue 1, January 1995, Pages 196-200
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Clinical Investigations in Critical Care: Articles
Pulmonary Fibrosis Correlates With Outcome in Adult Respiratory Distress Syndrome: A Study in Mechanically Ventilated Patients

https://doi.org/10.1378/chest.107.1.196Get rights and content

Study objective

The present study was carried out to evaluate the prognostic value of pulmonary fibrosis diagnosed on the basis of pulmonary samples obtained by fiberscopic transbronchial lung biopsy (TBLB) in patients treated for severe established adult respiratory distress syndrome (ARDS).

Setting

Intensive Care Unit of a University Hospital.

Patients

Consecutive patients with a diagnosis of established ARDS.

Interventions

Samples of pulmonary tissue (3 to 6 in each patient) were obtained by fiberoptic TBLB. Severity of pulmonary fibrosis was assessed based on pathologic changes. Hematoxylin and eosin and Masson's trichrome stains were performed on each tissue sample.

Main results

Twenty-two lung specimens were obtained from 25 consecutive patients with ARDS of various origin (postsurgical complications, 7 patients; multiple trauma, 8 patients; medical problems, 7 patients). Transbronchial lung biopsy was complicated by small or moderate hemorrhage in three patients. No case of pneumothorax was identified. Pathologic findings showed that 14 patients (64%) had pulmonary fibrosis, either mild (9 patients) or moderate to severe fibrosis (5 patients). In the patients with pulmonary fibrosis, mortality rate was 57% (8 out of 14 patients), which was significantly different (p <0.02) from the 0% mortality rate observed in patients without pulmonary fibrosis. Severity of pulmonary fibrosis (mild vs moderate and severe) did not influence outcome. With the exception of pathologic findings, characteristics of patients with and without pulmonary fibrosis (PaO2, PaCO2, the ratio of PaC2 to fraction of inspired oxygen, and positive end-expiratory pressure) were not different.

Conclusion

In the study patients, pulmonary fibrosis diagnosed on the basis of TBLB was closely related to fatality in established ARDS.

Section snippets

Clinical Data

This study was conducted in a medicosurgical ICU. Twenty-five consecutive patients with ARDS were prospectively included in the study. The protocol received approval from the Committee for the Protection of Human Subjects of our institution and informed consents were obtained from the patients' families. Adult respiratory distress syndrome was defined by the following criteria: (1) PaO2 less than 60 mm Hg with fraction of inspired oxygen (FIo2) of 0.5 or more; (2) bilateral diffuse infiltrates

Characteristics of the Patients

No lung specimen was obtained in three patients. Two of these patients died from multiple organ failure, and one was discharged from the hospital. Of the remaining 22 patients, 17 were men and 5 were women, with a mean age of 49.4±17 years. Simplified Acute Physiology Score was 12.4±3.3. Causes of ARDS were postsurgical complications in 7 patients, multiple trauma in 8 patients, and medical problems in the remaining 7 patients (neurological disorders, 3 patients; hematologic malignancy, 2

Discussion

In the present study, presence of histologic signs of pulmonary fibrosis significantly correlates with outcome in patients with established ARDS. Interstitial fibrosis occurs early in the course of ARDS. Hill et al3 showed that such abnormalities are found in half of their patients within the first 36 h of ARDS. This was confirmed by Costa Auler et al4 in patients with ARDS following cardiopulmonary bypass and by Ashbaugh and Maier5 in patients with ARDS from various origins. Zapol et al6 found

References (17)

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