The Use of Bronchoscopy During the Coronavirus Disease 2019 Pandemic

Abstract

BACKGROUND: The coronavirus disease 2019 (COVID-19) has swept the globe and is causing significant morbidity and mortality. Given that the virus is transmitted via droplets, open airway procedures such as bronchoscopy pose a significant risk to health-care workers (HCWs). The goal of this guideline was to examine the current evidence on the role of bronchoscopy during the COVID-19 pandemic and the optimal protection of patients and HCWs. STUDY DESIGN AND METHODS: A group of approved panelists developed key clinical questions by using the Population, Intervention, Comparator, and Outcome (PICO) format that addressed specific topics on bronchoscopy related to COVID-19 infection and transmission. MEDLINE (via PubMed) was systematically searched for relevant literature and references were screened for inclusion. Validated evaluation tools were used to assess the quality of studies and to grade the level of evidence to support each recommendation. When evidence did not exist, suggestions were developed based on consensus using the modified Delphi process. RESULTS: The systematic review and critical analysis of the literature based on six PICO questions resulted in six statements: one evidence-based graded recommendation and 5 ungraded consensus-based statements. INTERPRETATION: The evidence on the role of bronchoscopy during the COVID-19 pandemic is sparse. To maximize protection of patients and HCWs, bronchoscopy should be used sparingly in the evaluation and management of patients with suspected or confirmed COVID-19 infections. In an area where community transmission of COVID-19 infection is present, bronchoscopy should be deferred for nonurgent indications, and if necessary to perform, HCWs should wear personal protective equipment while performing the procedure even on asymptomatic patients.

Bronchoscopic procedures during COVID‐19 pandemic: Experiences in Turkey

“…16 The first American Association for Bronchology and Interventional Pulmonology statement was published in late March; in the following days, expert opinions on the use of bronchoscopy during the COVID-19 pandemic were published one after another. [17][18][19][20][21] While the use of PPE and bronchoscopy indications were similar between the published reports and our practice, not using negative pressure rooms, not testing all patients, using a reusable bronchoscope and only giving a 30-minute interval between the procedures are the notable differences between the reports and our practice. We proved that these differences did not cause any problems in the detection of COVID-19 in either patients and health care workers after the procedure.…”

COVID-19 Associated Invasive Pulmonary Aspergillosis: Diagnostic and Therapeutic Challenges

“…However, most patients with severe COVID-19 pneumonia are usually critically ill and hemodynamically unstable, which will preclude performing invasive procedures, such as bronchoscopy with a lavage or a lung biopsy. Furthermore, bronchoscopy is not recommended in patients with COVID-19 because of the risks this aerosol generating procedure imposes on both the patient and the attending healthcare worker, unless deemed life-saving [ 39 ]. According to current guidelines that are specific to different patient populations, the diagnosis of probable or putative invasive aspergillosis (IA) is made using a composite of host factors, clinical features, and mycological evidence of aspergillus infection [ 36 , 37 , 38 ].…”

The Predicative Clinical Features Associated with Chronic Cough That Has a Single Underlying Cause

“…In addition, it is inappropriate to conduct these diagnostic tests routinely during the outbreak of some vicious respiratory infectious disease such as coronavirus disease 2019 (COVID-19) transmitted via respiratory droplets and close contact. [12][13][14] Previous empiric therapy for chronic cough emphasized initial treatment directed at one of common causes of chronic cough, regardless of clinical features. 15,16 If specific clinical features can be identified to indicate the etiologies of chronic cough, empiric treatments may be more targeted.…”