tetano
Editor, Senior Moderator
Respir Care
. 2021 Nov 30;respcare.09405.
doi: 10.4187/respcare.09405. Online ahead of print.
Indications, Clinical Utility, and Safety of Bronchoscopy in COVID-19
Biplab K Saha[SUP] 1 [/SUP], Santu Saha[SUP] 2 [/SUP], Woon H Chong[SUP] 3 [/SUP], Scott Beegle[SUP] 3 [/SUP]
Affiliations
Abstract
Background: Bronchoscopy is an aerosol-generating procedure and routine use for patients with coronavirus disease 2019 (COVID-19) has been discouraged. The purpose of this review was to discuss the indications, clinical utility, and risks associated with bronchoscopy in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.
Methods: A literature search was performed by using appropriate key terms to identify all relevant articles from medical literature databases up to August 1, 2021.
Results: Twelve cohorts (9 retrospective and 3 prospective) reported the performance of 2,245 bronchoscopies in 1,345 patients with COVID-19. The majority of the subjects were male. Nearly two thirds of the bronchoscopies (62%) were performed for therapeutic indications; the rest (38%) were for diagnostic purposes. Bronchoalveolar lavage had an overall yield of 33.1% for SARS-CoV-2 in subjects with negative results of real-time polymerase chain reaction on nasopharyngeal specimens. The incidence of a secondary infection ranged from 9.3% to as high as 65%. Antibiotics were changed in a significant number of the subjects (14%-83%) based on the bronchoscopic findings. Bronchoscopy was well tolerated in most subjects except those who required noninvasive ventilation, in whom the intubation rate after the procedure was 60%. The rate of transmission of SARS-CoV-2 among health-care workers was minimum.
Conclusions: Bronchoscopy in patients with COVID-19 results in a significant change in patient management. Transmission of SARS-CoV-2 seems to be low with consistent use of appropriate personal protective equipment by health-care workers. Therefore, bronchoscopic evaluation should be considered for all diagnostic and therapeutic indications in this patient population.
Keywords: COVID-19; SARS-CoV-2; bronchoscopy; complications; indications.
. 2021 Nov 30;respcare.09405.
doi: 10.4187/respcare.09405. Online ahead of print.
Indications, Clinical Utility, and Safety of Bronchoscopy in COVID-19
Biplab K Saha[SUP] 1 [/SUP], Santu Saha[SUP] 2 [/SUP], Woon H Chong[SUP] 3 [/SUP], Scott Beegle[SUP] 3 [/SUP]
Affiliations
- PMID: 34848547
- DOI: 10.4187/respcare.09405
Abstract
Background: Bronchoscopy is an aerosol-generating procedure and routine use for patients with coronavirus disease 2019 (COVID-19) has been discouraged. The purpose of this review was to discuss the indications, clinical utility, and risks associated with bronchoscopy in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.
Methods: A literature search was performed by using appropriate key terms to identify all relevant articles from medical literature databases up to August 1, 2021.
Results: Twelve cohorts (9 retrospective and 3 prospective) reported the performance of 2,245 bronchoscopies in 1,345 patients with COVID-19. The majority of the subjects were male. Nearly two thirds of the bronchoscopies (62%) were performed for therapeutic indications; the rest (38%) were for diagnostic purposes. Bronchoalveolar lavage had an overall yield of 33.1% for SARS-CoV-2 in subjects with negative results of real-time polymerase chain reaction on nasopharyngeal specimens. The incidence of a secondary infection ranged from 9.3% to as high as 65%. Antibiotics were changed in a significant number of the subjects (14%-83%) based on the bronchoscopic findings. Bronchoscopy was well tolerated in most subjects except those who required noninvasive ventilation, in whom the intubation rate after the procedure was 60%. The rate of transmission of SARS-CoV-2 among health-care workers was minimum.
Conclusions: Bronchoscopy in patients with COVID-19 results in a significant change in patient management. Transmission of SARS-CoV-2 seems to be low with consistent use of appropriate personal protective equipment by health-care workers. Therefore, bronchoscopic evaluation should be considered for all diagnostic and therapeutic indications in this patient population.
Keywords: COVID-19; SARS-CoV-2; bronchoscopy; complications; indications.