REVIEW   Free access

Panminerva Medica 2021 December;63(4):529-38

DOI: 10.23736/S0031-0808.21.04533-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Bronchoscopy during COVID-19 pandemic, ventilatory strategies and procedure measures

Filippo PATRUCCO ^{1, 2} ✉, Giuseppe FAILLA ^{3, 4}, Giovanni FERRARI ⁵, Thomas GALASSO ⁶, Piero CANDOLI ⁶, Michele MONDONI ⁷, Roberto PIRO ⁸, Nicola C. FACCIOLONGO ⁸, Teresa RENDA ⁹, Mario SALIO ¹⁰, Raffaele SCALA ¹¹, Paolo SOLIDORO ^{12, 13}, Alessio MATTEI ¹², Paolo DONATO ¹⁴, Rosanna VASCHETTO ^{2, 14}, Piero E. BALBO ¹, on behalf of Interventional Pneumology and Lung Transplant Study Group of the Associazione Italiana Pneumologi Ospedalieri - Italian Thoracic Society (AIPO-ITS)

¹ Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità, Novara, Italy; ² Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; ³ Interventional Pneumology Unit, Department of Onco-Hematology and Pneumo-Hematology, AORN A. Cardarelli, Naples, Italy; ⁴ Diagnostic and Therapeutic Bronchoscopy Unit, ARNAS Civico e Benfratelli, Palermo, Italy; ⁵ Pulmonology and Semi-Intensive Respiratory Units, Medical Department, Mauriziano Hospital, Turin, Italy; ⁶ Interventional Pneumology Unit, Thoraco-Cardio-Vascular Department, Policlinico Sant’Orsola-Malpighi, Bologna, Italy; ⁷ Pulmonology Unit, Department of Cardio-Respiratory Medicine, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy; ⁸ Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy; ⁹ Pneumology and Thoraco-Pulmonary Physiopathology Unit, Department of Cardio-Thoraco-Vascular Medicine, Careggi Hospital, Florence, Italy; ¹⁰ Respiratory Diseases Unit, Department of Internal Medicine, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy; ¹¹ Pneumology Unit, Department of Cardio-Thoraco-Neuro-Vascular Medicine, San Donato Hospital, Azienda USL Toscana Sud Est, Arezzo, Italy; ¹² Pneumology Unit, Department of Cardiovascular and Thoracic Medicine, AOU Città della Salute e della Scienza, Turin, Italy; ¹³ Department of Medical Sciences, University of Turin, Turin, Italy; ¹⁴ Intensive Care Unit 1, Emergency Department, AOU Maggiore della Carità, Novara, Italy

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has changed bronchoscopy practices worldwide. Bronchoscopy is a high-risk aerosol-generating procedure with a potential for direct SARS-CoV-2 exposure and hospital-acquired infection. Current guidelines about personal protective equipment and environment considerations represent key competencies to minimize droplets dispersion and reduce the risk of transmission. Different measures should be put in field based on setting, patient’s clinical characteristics, urgency and indications of bronchoscopy. The use of this technique in SARS-CoV-2 patients is reported primarily for removal of airway plugs and for obtaining microbiological culture samples. In mechanically ventilated patients with SARS-CoV-2, bronchoscopy is commonly used to manage complications such as hemoptysis, atelectasis or lung collapse when prone positioning, physiotherapy or recruitment maneuvers have failed. Further indications are represented by assistance during percutaneous tracheostomy. Continuous positive airway pressure, non-invasive ventilation support and high flow nasal cannula oxygen are frequently used in patient affected by Coronavirus disease 2019 (COVID-19): management of patients’ airways and ventilation strategies differs from bronchoscopy indications, patient’s clinical status and in course or required ventilatory support. Sedation is usually administered by the pulmonologist (performing the bronchoscopy) or by the anesthetist depending on the complexity of the procedure and the level of sedation required. Lastly, elective bronchoscopy for diagnostic indications during COVID-19 pandemic should be carried on respecting rigid standards which allow to minimize potential viral transmission, independently from patient’s COVID-19 status. This narrative review aims to evaluate the indications, procedural measures and ventilatory strategies of bronchoscopy performed in different settings during COVID-19 pandemic.

KEY WORDS: Bronchoscopy; COVID-19; Noninvasive ventilation; Continuous positive airway pressure; Cannula