Chen Qing-Yun, He Yu-Sheng, Liu Kai, Cao Jing, Chen Yong-Xing
Department of Respiratory and Critical Care Medicine, Hainan General Hospital, Haikou 570311, Hainan Province, China.
Department of Internal Medicine, Hainan Province's Fucheng Drug Rehabilitation Centre, Haikou 570311, Hainan Province, China.
World J Clin Cases. 2021 Feb 16;9(5):1132-1138. doi: 10.12998/wjcc.v9.i5.1132.
Although the imaging features of coronavirus disease 2019 (COVID-19) are starting to be well determined, what actually occurs within the bronchi is poorly known. Here, we report the processes and findings of bronchoscopy in a patient with COVID-19 accompanied by respiratory failure.
A 65-year-old male patient was admitted to the Hainan General Hospital on February 3, 2020 for fever and shortness of breath for 13 d that worsened for the last 2 d. The severe acute respiratory syndrome coronavirus 2 nucleic acid test was positive. Routine blood examination on February 28 showed a white blood cell count of 11.02 × 10/L, 86.9% of neutrophils, 6.4% of lymphocytes, absolute lymphocyte count of 0.71 × 10/L, procalcitonin of 2.260 ng/mL, and C-reactive protein of 142.61 mg/L. Oxygen saturation was 46% at baseline and turned to 94% after ventilation. The patient underwent video bronchoscopy. The tracheal cartilage ring was clear, and no deformity was found in the lumen. The trachea and bilateral bronchi were patent, while the mucosa was with slight hyperemia; no neoplasm or ulcer was found. Moderate amounts of white gelatinous secretions were found in the dorsal segment of the left inferior lobe, and the bronchial lumen was patent after sputum aspiration. The right inferior lobe was found with hyperemia and mucosal erosion, with white gelatinous secretion attachment. The patient's condition did not improve after the application of therapeutic bronchoscopy.
For patients with COVID-19 and respiratory failure, bronchoscopy can be performed under mechanical ventilation to clarify the airway conditions. Protection should be worn during the process. Considering the risk of infection, it is not necessary to perform bronchoscopy in the mild to moderate COVID-19 patients.
尽管2019冠状病毒病（COVID-19）的影像学特征已开始得到明确，但支气管内实际发生的情况却鲜为人知。在此，我们报告1例伴有呼吸衰竭的COVID-19患者的支气管镜检查过程及结果。
一名65岁男性患者于2020年2月3日因发热、气短13天入院，近2天病情加重。严重急性呼吸综合征冠状病毒2核酸检测呈阳性。2月28日血常规检查显示白细胞计数为11.02×10⁹/L，中性粒细胞86.9%，淋巴细胞6.4%，淋巴细胞绝对值0.71×10⁹/L，降钙素原2.260 ng/mL，C反应蛋白142.61 mg/L。基线时血氧饱和度为46%，通气后升至94%。患者接受了电子支气管镜检查。气管软骨环清晰，管腔内未发现畸形。气管及双侧支气管通畅，黏膜轻度充血；未发现肿瘤或溃疡。左下叶背段发现中等量白色胶冻样分泌物，吸痰后支气管腔通畅。右下叶充血，黏膜糜烂，有白色胶冻样分泌物附着。治疗性支气管镜检查后患者病情未改善。
对于COVID-19合并呼吸衰竭的患者，可在机械通气下进行支气管镜检查以明确气道情况。操作过程中应佩戴防护用品。考虑到感染风险，轻至中度COVID-19患者无需进行支气管镜检查。
