Open Lung Biopsy in Acute Respiratory Distress Syndrome

Open lung biopsy (OLB) remains a valuable diagnostic tool in the evaluation of patients with acute respiratory distress syndrome (ARDS) when non-invasive methods fail to yield a specific aetiology. By obtaining lung tissue directly, OLB enables definitive histopathological assessment, often revealing diffuse alveolar damage (DAD) or alternative processes such as organising pneumonia, interstitial lung disease or opportunistic infections. Although ARDS is defined by clinical and radiological criteria, the underlying histology is heterogeneous and may have important implications for targeted therapy. In selected patients, early OLB can guide the introduction or withdrawal of immunomodulatory treatments, antimicrobial regimens or supportive measures, and may influence decisions around escalation or limitation of care. Safety and timing are central considerations; modern series report acceptable complication rates when OLB is performed by experienced teams under controlled ventilatory settings. The global significance of OLB in ARDS lies in its capacity to refine diagnosis, personalise management and improve understanding of lung repair and injury mechanisms in critical illness.

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Open Lung Biopsy in Acute Respiratory Distress Syndrome publication trend

The graph below shows the total number of articles in open lung biopsy in acute respiratory distress syndrome across all publications each year (not limited to Nature Index journals).

Technical terms

Acute respiratory distress syndrome (ARDS): A severe inflammatory lung injury characterised by diffuse pulmonary oedema, hypoxaemia and reduced lung compliance.

Open lung biopsy (OLB): A surgical procedure in which a portion of lung parenchyma is removed for histopathological examination, typically via thoracotomy or video-assisted techniques.

Diffuse alveolar damage (DAD): The hallmark pathological pattern of ARDS, featuring hyaline membrane formation, alveolar septal thickening and interstitial inflammation.

Diagnostic yield: The proportion of procedures that yield a definitive diagnosis, reflecting the clinical utility of a test or intervention.

Berlin definition: Consensus clinical criteria for ARDS diagnosis based on timing, radiographic changes, origin of oedema and severity of hypoxaemia.

References

1. A structured diagnostic algorithm for patients with ARDS. Critical Care (2023).
2. Diagnostic yield and therapeutic impact of open lung biopsy in the critically ill patient. PLOS ONE (2018).
3. Predicting the Impact of Diffuse Alveolar Damage through Open Lung Biopsy in Acute Respiratory Distress Syndrome—The PREDATOR Study. Journal of Clinical Medicine (2019).