Bronchoscopic Intervention May be Associated with Better Outcomes in Mechanically Ventilated Coronavirus Disease-19 Patients: A Case Series

Abstract

BACKGROUND: The emergence of a new strain of coronavirus infection, the coronavirus infection disease 2019 (COVID-19), has been a pandemic burden across the globe. Severe COVID-19, particularly in patients with acute respiratory distress syndrome (ARDS), is associated with increased risk of admission to intensive care unit (ICU), mechanical ventilation, and mortality. Bronchoscopy has been widely employed as an adjunctive therapy in mechanically ventilated patients. However, the use of bronchoscopy in patients with COVID-19 has been strictly limited due to aerosol transmission.
 CASE REPORT: We reported 3 COVID-19 Cases presented to the hospital with ARDS. All of the patients were immediately intubated to improve oxygenation. During admission, the patients produced immense airway secretions that might have resulted in partial airway obstruction. A conventional tracheal suctioning did not help to promote clinical improvement. We decided to perform bronchoscopy with controlled suctioning by following a very tight protocol to prevent aerosol formation. A significant clinical and respiratory improvement was observed in all patients following bronchoscopy. Three of them were transferred to regular ward, however, one patient died during hospitalization.
 CONCLUSION: Bronchoscopic procedures may provide significant therapeutic benefits in severe COVID-19 patients. However, it should be kept in mind that this procedure should only be performed with a rigorous protocol to reduce the risk of aerosol generation and subsequent viral transmission.

Therapeutic and Interventional Bronchoscopy Performed in Critically ill COVID-19 patients: A Systematic Review

“…The main complications observed in patients related to bronchoscopy in COVID-19 patients were no improvement in very few patients, minor bleeding, cellulitis, drop in oxygen saturation (SpO2) <90%, or desaturation, pneumothorax, site irritation, mild respiratory failure, and difficult to swallow were common during pre-COVID-19 era [71, 76, 35, 77, 21]. Several studies reported patient underwent bronchoscopic aspiration of secretions but died due to disease progression without mentioning any complication related to bronchoscope [78, 79, 26]. Technical problem and difficulty in swallowing two complications of bronchoscope observed in two studies, both used disposable bronchoscopes [25].…”

“…Bronchoscopy is a very potential tool available for diagnosis and treatment of various respiratory diseases [22, 79]. It was widely used during the pandemic to diagnose co-infection in patients, to overrule false RT-PCR results from the nasopharyngeal samples and to change antibiotics to mitigate life threatening situations caused by co-infection [38].…”