• Ludovic Gerard, Thomas Bidoul, Diego Castanares-Zapatero, Xavier Wittebole, Valérie Lacroix, Antoine Froidure, Delphine Hoton, and Pierre-François Laterre.
• Department of Critical Care Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium.
• Crit. Care Med. 2018 Jun 1; 46 (6): 907-914.

ObjectivesApproximately half of the patients undergoing lung biopsy for nonresolving acute respiratory distress syndrome exhibit another histologic pattern than diffuse alveolar damage, with some of the pathologies characterized by a potential response to corticosteroids. This study aimed to assess whether open lung biopsy performed in the ICU for nonresolving acute respiratory distress syndrome was able to identify steroid-sensitive diseases and whether patients with a steroid-sensitive pathology experienced different clinical courses and outcomes.DesignRetrospective analysis.SettingOne 22-bed mixed ICU within a tertiary medical center.PatientsPatients age greater than or equal to 16 years old who met the Berlin definition for acute respiratory distress syndrome and underwent open lung biopsy from January 2007 to January 2017.InterventionsNone.Measurements And Main ResultsDuring the study period, 695 patients diagnosed with acute respiratory distress syndrome were identified, 51 (7%) of whom underwent open lung biopsy. An alternative diagnosis to diffuse alveolar damage was found in 29 patients (57%), and a steroid-sensitive pathology was identified in 19 (37%). In-hospital and 180-day mortality rates were 55% and 61%, respectively. There was a significant difference in hospital mortality and 180-day mortality rates between patients with steroid-sensitive pathology and those with steroid-resistant pathology (37% vs 65%; p < 0.045 and 37% vs 75%; p < 0.007, respectively). We did not identify any variable that could reliably predict a steroid-sensitive histologic pattern before open lung biopsy.ConclusionsOpen lung biopsy was able to identify a steroid-sensitive pathology in a significant proportion of nonresolving acute respiratory distress syndrome patients. These patients had a better outcome, with lower hospital mortality and 180-day mortality.

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