Safety and efficacy of bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB) for critically ill patients under invasive mechanical ventilation: a prospective, single-arm trial

ObjectivesConventional lung biopsy for critically ill patients who under invasive mechanical ventilation (IMV) is limited due to high risks of procedure-related complications. We developed a novel technique named bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB) to mitigate the risks of biopsy under IMV, but its safety and efficacy have not been prospectively evaluated. MethodsIn this prospective, single-arm trial (Chictr.org, ChiCTR2100054047), invasively ventilated patients with undiagnosed lung opacities were screened and underwent BUS-PTNB after enrollment. The peri-operative conditions, severity of complications, pathological findings, and tissue-based metagenomic next-generation sequencing (mNGS) results were systemically evaluated. ResultsA total of 22 critically ill patients (18 men, mean age, 64.2 years [SD 11.7], APACHE II score, 27.0 [SD 5.6], PaO2/FiO2 ratio, 120.5 [IQR 91.9-169.1]) under IMV were enrolled in the study. Throughout the procedure, there were no significant changes in respiratory rate or PaO2. Biopsy-related complications occurred in 3 patients (13.6%), including pneumothorax (n=1, 4.5%), intrabronchial hemorrhage (n=2, 9.1%), and hemothorax (n=3, 13.6%). Notably, one patient (P10) required a blood transfusion due to hemothorax, which was classified as a severe complication (1/22, 4.5%). Satisfactory biopsy samples were obtained from 21 patients (95.5%) for pathological study and from all 22 patients (100%) for mNGS. ConclusionsThe novel BUS-PTNB is a promising bedside biopsy technique for ICU patients under IMV with acceptable complication risk. This technique may prove instrumental in advancing pathological studies of severe lung diseases. Key points and Clinical Relevance StatementO_ST_ABSQuestionC_ST_ABSWe developed bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB) for patients under invasive mechanical ventilation, but its safety and efficacy have not been prospectively evaluated. FindingsPatients vital signs showed no significant fluctuations. Biopsy-related complications occurred in 3 patients out of 22. Satisfactory samples were obtained for pathological study and mNGS. Clinical RelevanceBUS-PTNB is a promising bedside biopsy technique for ICU patients under IMV with acceptable complication risk. This technique may prove instrumental in advancing pathological studies of severe lung diseases.