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.
JollietP, ChevroletJC. Bronchoscopy in the intensive care unit. Intensive Care Med, 1992; 18(3):160-169.
2.
JinF, MuD, ChuD, FuE, XieY, LiuT. Severe complications of bronchoscopy. Respiration, 2008; 76(4):429-433.
3.
TranK, CimonK, SevernM, Pessoa-SilvaCL, ConlyJ. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One, 2012; 7(4):e35797.
4.
SahaBK, BonnierA, ChongW. Antimalarials as antivirals for COVID-19: believe it or not!. Am J Med Sci, 2020; 360(6):618-630.
5.
SahaBK, ChongWH, AustinA, KathuriaR, DatarP, ShkolnikB, et al. Pleural abnormalities in COVID-19: a narrative review. J Thorac Dis, 2021; 13(7):4484-4499.
6.
CevikM, KuppalliK, KindrachukJ, PeirisM. Virology, transmission, and pathogenesis of SARS-CoV-2. BMJ, 2020; 371:m3862.
7.
WahidiMM, LambC, MurguS, MusaniA, ShojaeeS, SachdevaA, et al. American Association for Bronchology and Interventional Pulmonology (AABIP) Statement on the Use of Bronchoscopy and Respiratory Specimen Collection in Patients With Suspected or Confirmed COVID-19 Infection. J Bronchology Interv Pulmonol, 2020; 27(4):e52-e54.
8.
WahidiMM, ShojaeeS, LambCR, OstD, MaldonadoF, EapenG, et al. The use of bronchoscopy during the coronavirus disease 2019 pandemic. Chest, 2020; 158(3):1268-1281.
9.
LuoF, DarwicheK, SinghS, TorregoA, SteinfortDP, GaspariniS, et al. Performing bronchoscopy in times of the COVID-19 pandemic: practice statement from an international expert panel.Respiration, 2020; 99(5):417-422.
10.
GuedesF, Boléo-ToméJP, RodriguesLV, BastosHN, CampainhaS, de SantisM, et al. Recommendations for interventional pulmonology during COVID-19 outbreak: a consensus statement from the Portuguese Pulmonology Society. Pulmonology, 2020; 26(6):386-397.
11.
MahmoodK, AbbottM, Van NostrandK, BecharaR, GonzalezAV, BruckerA, et al. Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience. BMJ Open Resp Res, 2021; 8(1):e000962.
12.
GotoT. Effect of the coronavirus disease pandemic on bronchoscopic diagnosis of lung cancer in a provincial city in Japan. J Cardiothorac Surg, 2021; 16(1):115.
13.
HilzenratRA, DeenSA, YeeJ, GrantKA, AshrafiAS, CoughlinS, et al. Thoracic surgeon impressions of the impact of the COVID-19 pandemic on lung cancer care–lessons from the first wave in Canada. Curr Oncol, 2021; 28(1):940-949.
14.
PageMJ, McKenzieJE, BossuytPM, BoutronI, HoffmannTC, MulrowCD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev, 2021 Mar 29;10(1):89.
15.
StangA. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010; 25(9):603-615.
16.
MehtaR, BansalS, KumarA, ThorboleA, ChakravarthiL, KalpakamH. Bronchoscopy in COVID19 ARDS patients on mechanical ventilation – a prospective study. medRxiv. 2021.02.02.21250362, 2021.
17.
GuarinoC, CesaroC, FiorentinoG, RossiF, PolverinoBM, FragranzaF, et al. Bronchoscopy in COVID-19 patients: when, how and why. Experience in clinical practice. Monaldi Arch Chest Dis, 2021; 91(2).
18.
TorregoA, PajaresV, Fernández-AriasC, VeraP, ManceboJ. Bronchoscopy in patients with COVID-19 with invasive mechanical ventilation: a single-center experience. Am J Respir Crit Care Med, 2020; 202(2):284-287.
19.
BaronA, HachemM, Tran Van NhieuJ, BotterelF, FouratiS, CarteauxG, et al. Bronchoalveolar lavage in patients with COVID-19 with invasive mechanical ventilation for acute respiratory distress syndrome. Ann Am Thorac Soc, 2021; 18(4):723-726.
20.
ChangSH, JiangJ, KonZN, WilliamsDM, GeraciTC, SmithDE, et al. Safety and efficacy of bronchoscopy in critically ill patients with coronavirus disease 2019. Chest, 2021; 159(2):870-872.
21.
MondoniM, Sferrazza PapaGF, RinaldoR, FaverioP, MarruchellaA, D’ArcangeloF, et al. Utility and safety of bronchoscopy during the SARS-CoV-2 outbreak in Italy: a retrospective, multicentre study. Eur Respir J, 2020; 56(4):2002767.
22.
PatruccoF, AlberaC, BellocchiaM, FociV, GavelliF, CastelloLM, et al. SARS-CoV-2 detection on bronchoalveolar lavage: an Italian multicenter experience. Respiration, 2020; 99(11):970-978.
23.
BruyneelM, GabrovskaM, RummensP, RomanA, ClausM, StevensE, et al. Bronchoscopy in COVID-19 intensive care unit patients. Respirology, 2020; 25(12):1313-1315.
24.
LoorK, ÁlvarezA, Felipe MontielA, FerrerR, RocaO, García-de-AciluM, et al. Safety, diagnostic, and therapeutic value of flexible bronchoscopy in critically ill COVID-19 patients. Can J Anaesth, 2020; 68(3)434-435.
25.
Arenas-De LarrivaM, Martín-DeLeonR, Urrutia RoyoB, Fernández-NavamuelI, Gimenez VelandoA, Nuñez GarcíaL, et al. The role of bronchoscopy in patients with SARS-CoV-2 pneumonia. ERJ Open Res, 2021; 7(3):00165-2021.
26.
CornelissenCG, BergsI, MüllerAG, DaherA, KerstenA, BalfanzP, et al. Broncho-alveolar lavage in patients with acute respiratory distress syndrome due to COVID-19. Intern Med J, 2021; 51(6):965-967.
27.
ÇelebiG, PişkinN, Çelik BekleviçA, AltunayY, Salcı KeleşA, TüzMA, et al. Specific risk factors for SARS-CoV-2 transmission among health care workers in a university hospital. Am J Infect Control, 2020; 48(10):1225-1230.
28.
KeeleyAJ, EvansC, ColtonH, AnkcornM, CopeA, StateA, et al. Roll-out of SARS-CoV-2 testing for healthcare workers at a large NHS Foundation Trust in the United Kingdom. Euro Surveill, 2020; 25(14):2000433.
29.
GaoCA, BaileyJI, WalterJM, ColemanJM, MalsinES, ArgentoAC, et al. Bronchoscopy on intubated patients with COVID-19 is associated with low infectious risk to operators. Ann Am Thorac Soc, 2021; 18(7):1243-1246.
30.
WangW, XuY, GaoR, LuR, HanK, WuG, TanW. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA, 2020; 323(18):1843-1844.
31.
SanivarapuR, KangJ, AnjumF. Rare endobronchial polyps due to SARS-CoV-2 infection. J Bronchology Interv Pulmonol, 2021; 28(2):e31-e33.
32.
WangC, XieJ, ZhaoL, FeiX, ZhangH, TanY, et al. Alveolar macrophage dysfunction and cytokine storm in the pathogenesis of two severe COVID-19 patients. EBioMedicine, 2020; 57:102833.
33.
MenterT, HaslbauerJD, NienholdR, SavicS, HopferH, DeigendeschN, et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology, 2020; 77(2):198-209.
34.
Vidal MeloMF, HarrisRS, LayfieldD, MuschG, VenegasJG. Changes in regional ventilation after autologous blood clot pulmonary embolism. Anesthesiology, 2002; 97(3):671-681.
35.
ChongWH, SahaBK, RamaniA, ChopraA. State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia. Infection, 2021; 49(4):591-605.
36.
Garcia-VidalC, SanjuanG, Moreno-GarcíaE, Puerta-AlcaldeP, Garcia-PoutonN, ChumbitaM, et al.; COVID-19 Researchers Group. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect, 2021; 27(1):83-88.
37.
FuY, YangQ, XuM, KongH, ChenH, FuY, et al. Secondary bacterial infections in critical ill patients with coronavirus disease 2019. Open Forum Infect Dis, 2020; 7(6):ofaa220.
38.
Karmen-TuohyS, CarlucciPM, ZervouFN, ZacharioudakisIM, RebickG, KleinE, et al. Outcomes among HIV-positive patients hospitalized with COVID-19. J Acquir Immune Defic Syndr, 2020; 85(1):6-10.
39.
ChongWH, NeuKP. Incidence, diagnosis and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA): a systematic review. J Hosp Infect, 2021; 113:115-129.
40.
SahaBK, ChongW. A 61-year-old man with influenza pneumonia and new onset hemoptysis. Chest, 2021; 160(2):e181-e184.
41.
RECOVERY Collaborative Group; HorbyP, LimWS, EmbersonJR, MafhamM, BellJL, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med, 2021; 384(8):693-704.
42.
KhilnaniGC, HaddaV. Corticosteroids and ARDS: a review of treatment and prevention evidence. Lung India, 2011; 28(2):114-119.
EberE, GoussardP. Bronchoscopy precautions and recommendations in the COVID-19 pandemic. Paediatr Respir Rev, 2021; 37:68-73.
45.
World Health Organization (WHO). Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. Available at: WHO/2019-nCoV/IPC/2020.3. Accessed March 18, 2020.
