The role of bronchoscopy in patients with SARS-CoV-2 pneumonia

Abstract

BackgroundThe role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate. Patients and methods: This observational multicenter study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June, 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression.ResultsA total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). One hundred forty-seven bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperemia (11.4%). The independent predictors of in-hospital mortality were: older age (Odds ratio [OR]=1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR=1.60; p=0.041), absence of mucosal hyperemia (OR=0.49; p=0.041) and the presence of haematic secretions (OR=1.79; p=0.032).ConclusionsBronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19.

Ex-vivo mucolytic and anti-inflammatory activity of BromAc in tracheal aspirates from COVID-19

“…The character of the sputum in COVID-19 is also highly viscous [10] and a higher proportion of critically ill COVID patients had grade 3 sticky sputum [11]. Bronchoscopy has revealed extensive mucus plugging or mucus in 64% [12] and 82% [13] and improvement in oxygenation after clearance. Mucus plugs were an adverse prognostic factor [13].…”

“…Bronchoscopy has revealed extensive mucus plugging or mucus in 64% [12] and 82% [13] and improvement in oxygenation after clearance. Mucus plugs were an adverse prognostic factor [13]. Endotracheal tube obstruction due to mucinous sputum is also a problem recognised far more frequently in COVID-19 patients than others requiring ventilation [14].…”

Diagnostic Role of Bronchoalveolar Lavage in Patients with Suspected SARS-CoV-2 Pneumonia and Negative Upper Respiratory Tract Swab: A Systematic Review and Meta-Analysis

“… Overall proportion of SARS-CoV-2 positivity in BAL fluid [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. …”

“… Graphical display of the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) results, according to risk of bias and applicability concerns [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. …”

The Role of Bronchoscopy in the Diagnosis and Management of Patients with SARS-Cov-2 Infection

“…In another study that evaluated a population with similar clinical characteristics, but with only two consecutive negative nasopharyngeal swabs, a low diagnostic yield of BALF for detecting SARS-CoV-2 virus (36%) was reported [22].…”