Saha Biplab K, Saha Santu, Chong Woon H, Beegle Scott
Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri.
Division of Internal Medicine, Bangladesh Medical College, Dhaka, Bangladesh.
Respir Care. 2022 Feb;67(2):241-251. doi: 10.4187/respcare.09405. Epub 2021 Nov 30.
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.
A literature search was performed by using appropriate key terms to identify all relevant articles from medical literature databases up to August 1, 2021.
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.
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.
支气管镜检查是一种会产生气溶胶的操作，不鼓励对2019冠状病毒病（COVID-19）患者进行常规使用。本综述的目的是讨论严重急性呼吸综合征冠状病毒2（SARS-CoV-2）肺炎患者支气管镜检查的适应证、临床效用及相关风险。
通过使用适当的关键词进行文献检索，以识别截至2021年8月1日医学文献数据库中的所有相关文章。
12个队列研究（9项回顾性研究和3项前瞻性研究）报告了1345例COVID-19患者接受的2245次支气管镜检查情况。大多数受试者为男性。近三分之二（62%）的支气管镜检查是出于治疗目的；其余（38%）是用于诊断。对于鼻咽标本实时聚合酶链反应结果为阴性的受试者，支气管肺泡灌洗对SARS-CoV-2的总体检出率为33.1%。继发感染的发生率在9.3%至高达65%之间。基于支气管镜检查结果，相当数量的受试者（14% - 83%）更换了抗生素。除了需要无创通气的受试者外，大多数受试者对支气管镜检查耐受性良好，这些受试者检查后的插管率为60%。医护人员中SARS-CoV-2的传播率极低。
COVID-19患者的支气管镜检查导致患者管理发生显著变化。医护人员持续使用适当的个人防护设备时，SARS-CoV-2的传播似乎较低。因此，对于该患者群体的所有诊断和治疗适应证，均应考虑进行支气管镜评估。
