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Panminerva Medica 2021 Oct 04

DOI: 10.23736/S0031-0808.21.04533-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

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 Associazione Italiana Pneumologi Ospedalieri - Italian Thoracic Society (AIPO-ITS) study group

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


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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. Finally, 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; Non invasive ventilation; Continuous positive airway pressure; High flow nasal cannula

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