Bronchoscopy in COVID-19 patients: When, how and why. Experience in clinical practice

Abstract

Severe Acute Respiratory Syndrome due to Coronavirus-19 (SARS-CoV-2) is caused by combined alveolar-capillary lung damage, with bilateral pneumonia and thrombosis, which often causes respiratory failure. Proper COVID-19 management requires high skills in airway control and the need to perform aerosol-generating procedures such as bronchoscopy, which can increase the possibility of virus spreading among healthcare professionals. In an epidemiologically delicate moment, the multidisciplinary decision on “WHEN, HOW and WHY” to perform bronchoscopies minimizing the risk of COVID-19 transmission, represented a great challenge for all specialists engaged in bronchoscopic procedures. In this work authors want to share all technical aspects of 87 videobronchoscopies performed in confirmed or suspected COVID-19 patients, from 3rd to 6th January 2020, describing the reason, the organizational and operational model and patients characteristics. Was also evaluated the impact of high-risk procedures such as bronchoscopy on the personnel involved. The disclosure of all technical details, represents, in the opinion of the authors, an important contribution, capable of providing support to all physicians engaged in bronchoscopy procedures in confirmed or suspected COVID-19 patients.

Severe Thrombocytopenia as a Manifestation of COVID-19 Infection

“…In case 2, there were no respiratory symptoms identified during hospitalization which were consistent with the chest CT findings, explaining why no other investigation was performed. Bronchoscopy, is rarely used for the diagnosis of COVID-19; it is used only if nasopharyngeal swabs for RT-PCR are negative and there is another hypothesized infectious diagnosis that would significantly change the clinical management [33]. The indications for bronchoscopy in patients with SARS-CoV-2 infection are clearly stated and refer especially to intubated patients in the ICU: lung resistance increase, suspected alveolar hemorrhage, reposition of the tracheal tube, endoscopic tracheotomy assistance, difficult intubation assistance, suspected aspiration pneumonia, suspected tracheal injury, or suspected obstruction by secretions or clots [33].…”

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

“…It is useful for patients with severe or critical condition, deposition of excessive mucus or secretions are commonly seen in these COVID-19 patients (25, 18, 20-21, 36-37). Bronchoscopy should not be performed in COVID-19 patients with severe respiratory insufficiency managed under non-invasive mechanical ventilation (12). Removal of mucus plug, gelatinous mucus, thick hematic secretions caused due to hyperaemia, bronchoscopy was a lifesaving procedure for these patients [38, 39, 40, 41, 42].…”

Utility of bronchoalveolar lavage for COVID-19: a perspective from the Dragon consortium.

“…Several studies have evaluated the utility of BAL in the critically ill patients, two were prospective. 18,19,[33][34][35][36] A summary of BAL findings in critically ill patients is reported in Table 1 and 2. The highest positivity for SARS-Cov-2 detection in BAL performed in critically ill patients has been reported by Wang W et al, 93% (95%CI 074-1.00; N total BAL = 15) and Yang Y et al, 68% (95% CI 056-0.79; N total BAL = 44).…”