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

Abstract

Background: Coronavirus disease 2019 (COVID19) is a highly infectious disease responsible for huge number of deaths in global population. Bronchoscopy was contraindicated for acute respiratory failure in critical patients due to possible transmission of virus to healthcare provider due to aerosol generating procedure (AGP). The safety, efficacy, complication rate, deaths, and transmission rate of virus to healthcare workers due to therapeutic and interventional bronchoscopy performed on COVID19 patients are accessed. Methods: A systematic review of literature was performed as per PRISMA 2020 guidelines. To obtain literatures available in PubMed, MEDLINE, and Google Scholars with timeline from 1st Jan 2020 to 10th Dec 2021. Databases were searched with MeSH terms bronchoscopy and COVID-19 it fetched 7350 articles. Applying primary inclusion criteria of bronchoscopy in COVID19 patients. Secondary inclusion criteria therapeutic and interventional bronchoscopy excluding the articles on diagnostic bronchoscopy. Result: Total 72 clinically relevant literatures were identified and included for further review. 1887/2558 patients underwent bronchoscopy for treatment of severe or critical COVID19 pneumonia. therapeutic bronchoscopy was performed in 1241/1887 (65.8%) patients and interventional bronchoscopy was performed in 831/1887 (44.03%) patients. Overall, complications observed in 200/1887 (10.5%) patients. Total, 579/1887 (30%) patients died as per the literatures. Total 15 HCW (8%) were found infected during the studies. It led to successful completion of procedures in 924/940 (98.3%) patients. All three types of bronchoscopes were found to be safe for the patients. The safety, efficacy, complication rate to be 97.5%, and 98.3%, and 2.5% respectively in severely SARSCoV2 infected patients undergoing bronchoscopy. Conclusion: This study suggests that bronchoscopy is a safe and effective procedure to be performed in patients suffering from COVID19 pneumonia. Proper use of personal protective equipments (PPE) during bronchoscopic procedure reduced the risk of transmission of the virus from the patients to the healthcare provider.