Bronchoalveolar Lavage in Patients with COVID-19 with Invasive Mechanical Ventilation for Acute Respiratory Distress Syndrome

Baron, Audrey; Hachem, Melissa; Nhieu, Jeanne Tran Van; Botterel, Françoise; Fourati, Slim; Carteaux, Guillaume; Prost, Nicolas de; Maître, Bernard; Mekontso-Dessap, Armand; Schlemmer, F.

doi:10.1513/annalsats.202007-868rl

Cited by 37 publications

(80 citation statements)

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“…Torrego et al reported 28.6%, Bruyneel et al 60% and Baron et al 86% positive culture cases. (4-6) The spectrum of microorganisms varies -in previous studies, the commonest microorganisms isolated were Pseudomonas and Staphylococcus aureus , while our study had predominantly Klebsiella pneumonia and Acinetobacter baumanii . This variation may not be specific to COVID-19 but likely represents superinfection with resident ICU flora in sick patients with comorbidities, prolonged ICU stay, and a viral pneumonia complicated with uniform use of steroids and antibiotics.…”

Section: Discussionmentioning

confidence: 54%

“…(5) Baron et al did BAL for a microbiological purpose in all cases -to confirm SARS-CoV-2 infection (7%), after a negative RT-PCR NP swab, for suspicion of ventilator-associated pneumonia (39%) or invasive aspergillosis (14%) or to rule out superinfection before starting a corticosteroid course (43%). (6) All procedures were done in MV patients, similar to our study.…”

Section: Discussionmentioning

confidence: 86%

“…(5) Baron et al performed 28 bronchoscopies between March 31 and June 2020 on 24 COVID-19 patients. (6) The median time [IQR] from MV to BAL was 16 [10-21] days. In our study, median symptom-onset (SO) to hospitalization duration was 7 (IQR;4-10) days, SO to MV was 10 days (7 – 13.2) and SO to bronchoscopy was 14 days (10-20), while MV to bronchoscopy was 2.5 days (1-6.5).…”

Section: Discussionmentioning

confidence: 99%

“…Compared to other less invasive microbiological tests, BAL identified at least one previously undetected pathogen in 46% cases. (6)…”

Section: Discussionmentioning

confidence: 99%

“…al., COVID-19 diagnosis was confirmed on BAL RT-PCR in 2 patients (7%). (6) Patrucco et al reported that of the 120 patients with 2 negative swabs, SARS-CoV-2 was isolated (27.5%) on BAL. (9)…”

Section: Discussionmentioning

confidence: 99%

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Bronchoscopy in COVID19 ARDS patients on mechanical ventilation – a prospective study

Mehta

Bansal

Kumar

et al. 2021

Preprint

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Background: Bronchoscopy has been done sparingly in COVID19 patients due to the risk of aerosol generation, with few reports describing its clinical utility. We describe a large case series of bronchoscopy in mechanically ventilated (MV) COVID-19 patients outlining the procedural, clinical, utilitarian and safety aspects. Methods: Bedside bronchoscopy was performed in suspected or confirmed COVID-19 cases on MV; only positive cases were included in the study. Demographic, clinical, bronchoscopic and laboratory findings were noted and analysed. Results: 98 procedures were performed on 61 patients, mean age of 62.1 years, 51 (83.6%) males. 42 patients (69%) had at least 1 co-morbidity. Major indications for bronchoscopy were new radiographic infiltrates with clinical deterioration, increased endotracheal tube (ETT) secretions and haemorrhagic secretions/hemoptysis. Common findings were copious secretions in 87 (88.8%), purulent in 61%, mucoid in 18%, haemorrhagic in 7% and frothy in 14% cases. Morphologically, hyperaemic airways were seen in 85 (86.7%) cases, ranging from mild (61%) to moderate-severe (39%). On the management front, antibiotics were changed in 31 (31.6%) cases based on bronchoscopic findings. Other significant changes included reduction or stopping of steroids and anticoagulation, fluid, and diuretic adjustment and ETT repositioning. The incidence of bacterial superinfection was also high (54% culture positivity for various bacteria), a significant number (94%) with multi-drug resistant organisms. Fungi were seen in 7 cases (7.1%). Pneumocystis jiroveci was not seen and cytology did not show any viral inclusions. Therapeutic mucus plug removal was done in 30 cases (30.6%), and hemoptysis control in 4% cases. The procedures were safe with no complications, and none of the HCW developed any COVID19 infection. Conclusion: Bronchoscopy in critically ill MV COVID-19 patients contributes on both diagnostic and therapeutic fronts and can significantly influence management decisions. With adequate precautions and standard protocols, it is safe for both HCW and patients.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 86%