“…Among all studies, 18 were conducted in European countries. Overall, the 32 selected studies enrolled 2517 patients with a median of 40 [ 12 – 60 ] patients per study, and a median patient age of 60 [53–64] years. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Finally, in the era of the ongoing epidemic, a careful choice of oxygenation strategy should also be done in case of patients with suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. FOB is considered as aerosol generating procedure generating a significant number of droplets that can be contagious for other patients and the healthcare personnel [ 60 ]. Operators should firstly check the infection by SARS-CoV-2 through molecular test with naso-pharyngeal swabs; in case of positivity, full personal protective equipment (i.e.…”
Section: Discussionmentioning
confidence: 99%
“…In principle, the use of a helmet for CPAP or NIV with a good seal around the neck is preferable, and, as abovementioned, the appropriate use of personal protective equipment is mandatory. In addition, simple practical measurements like reducing the number of assisting personnel and cough restriction with the administration of oropharyngeal lignocaine can minimize the contamination risk [ 60 ]. Of note, masks with vent holes should be avoided and a filter between the mask and the vent or PEEP valve is advisable to reduce viral transmission [ 61 ].…”
During flexible fiberoptic bronchoscopy (FOB) the arterial partial pressure of oxygen can drop, increasing the risk for respiratory failure. To avoid desaturation episodes during the procedure several oxygenation strategies have been proposed, including conventional oxygen therapy (COT), high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV). By a review of the current literature, we merely describe the clinical practice of oxygen therapies during FOB. We also conducted a pooled data analysis with respect to oxygenation outcomes, comparing HFNC with COT and NIV, separately. COT showed its benefits in patients undergoing FOB for broncho-alveolar lavage (BAL) or brushing for cytology, in those with peripheral arterial oxyhemoglobin saturation < 93% prior to the procedure or affected by obstructive disorder. HFNC is preferable over COT in patients with mild to moderate acute respiratory failure (ARF) undergoing FOB, by improving oxygen saturation and decreasing the episodes of desaturation. On the opposite, CPAP and NIV guarantee improved oxygenation outcomes as compared to HFNC, and they should be preferred in patients with more severe hypoxemic ARF during FOB.
“…Among all studies, 18 were conducted in European countries. Overall, the 32 selected studies enrolled 2517 patients with a median of 40 [ 12 – 60 ] patients per study, and a median patient age of 60 [53–64] years. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Finally, in the era of the ongoing epidemic, a careful choice of oxygenation strategy should also be done in case of patients with suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. FOB is considered as aerosol generating procedure generating a significant number of droplets that can be contagious for other patients and the healthcare personnel [ 60 ]. Operators should firstly check the infection by SARS-CoV-2 through molecular test with naso-pharyngeal swabs; in case of positivity, full personal protective equipment (i.e.…”
Section: Discussionmentioning
confidence: 99%
“…In principle, the use of a helmet for CPAP or NIV with a good seal around the neck is preferable, and, as abovementioned, the appropriate use of personal protective equipment is mandatory. In addition, simple practical measurements like reducing the number of assisting personnel and cough restriction with the administration of oropharyngeal lignocaine can minimize the contamination risk [ 60 ]. Of note, masks with vent holes should be avoided and a filter between the mask and the vent or PEEP valve is advisable to reduce viral transmission [ 61 ].…”
During flexible fiberoptic bronchoscopy (FOB) the arterial partial pressure of oxygen can drop, increasing the risk for respiratory failure. To avoid desaturation episodes during the procedure several oxygenation strategies have been proposed, including conventional oxygen therapy (COT), high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV). By a review of the current literature, we merely describe the clinical practice of oxygen therapies during FOB. We also conducted a pooled data analysis with respect to oxygenation outcomes, comparing HFNC with COT and NIV, separately. COT showed its benefits in patients undergoing FOB for broncho-alveolar lavage (BAL) or brushing for cytology, in those with peripheral arterial oxyhemoglobin saturation < 93% prior to the procedure or affected by obstructive disorder. HFNC is preferable over COT in patients with mild to moderate acute respiratory failure (ARF) undergoing FOB, by improving oxygen saturation and decreasing the episodes of desaturation. On the opposite, CPAP and NIV guarantee improved oxygenation outcomes as compared to HFNC, and they should be preferred in patients with more severe hypoxemic ARF during FOB.
“…Other literature also states that modification of bronchoscopy technique to minimize exposure to medical personnel is highly recommended during the COVID-19 pandemic [13] . Because, it was reported that 30% of COVID-19 patients in the ICU experienced bronchoalveolar lavage (BAL) and worsening hypoxia so that the bronchoscopy procedure could be used to prevent multidrug resistance antibiotics [9] , [14] . The efficacy of bronchoscopy in COVID-19 has not been published numerically but bronchoscopy can increase lung capacity in patients over 50 years of age [15] .…”
Section: Discussionmentioning
confidence: 99%
“…The equipment used is a reusable bronchoscopy operated by a professional lung specialist. Bronchoscopy is inserted through an endotracheal tube that has been previously installed until it finds the location of the BAL which washing to be finished [9] . Bronchoscopy operators have received training and certification in this procedure since 2013.…”
Background and AimFlexible bronchoscopy (FB) poses a risk of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission due to aerosol generation. This study aimed to assess the utilization, indications, outcomes, and safety of FB in pediatric patients for noncoronavirus disease of 2019 (COVID‐19) reasons during the pandemic.Materials and MethodsWe retrospectively analyzed pediatric patients who underwent FB for non‐COVID‐19 indications at a tertiary children's hospital's pulmonary clinic during the COVID‐19 pandemic. Patients showed no COVID‐19 symptoms and tested negative for SARS‐CoV‐2 by real‐time polymerase chain reaction (PCR) of nasopharyngeal and throat swabs within 24 h before the procedure. FBs were conducted in the operating room, with healthcare professionals (HCPs) wearing personal protective equipment, including medical N95 masks, gloves, gowns, and eye protection.ResultsBetween March 2020 and April 2022, 167 pediatric patients underwent FB for non‐COVID‐19 indications. Common indications included foreign body aspiration (22.7%), stridor (10.1%), and atelectasis (8.9%). No COVID‐19 symptoms were observed in patients on the 1st and 10th days post‐FB. During the 1‐month follow‐up, 52 patients underwent SARSCoV‐2 PCR testing, and one patient tested positive in the third week after the procedure. None of the HCPs in the FB team experienced COVID‐19 symptoms or tested positive for SARS‐CoV‐2.ConclusionA bronchoscopy protocol with safety precautions minimized the risk of COVID‐19 transmission, allowing safe FB performance for non‐COVID‐19 indications in pediatric patients during the pandemic. The experience gained in FB during COVID‐19 is valuable for similar situations in the future.
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