A study of the utility and safety of bronchoscopy in mechanically ventilated COVID19 ARDS: Transgressing the conventional guidelines

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Ravindra Mehta Sameer Bansal Ashwin Kumar Anmol Thorbole Chakravarthi Loknath Hariprasad Kalpakam


Background: Bronchoscopy has been done sparingly in COVID19 patients due to the risk of aerosol generation. We describe a study on targeted bronchoscopy in mechanically ventilated (MV) COVID-19 patients outlining the procedural, clinical, utilitarian and safety aspects.

Methods: Bedside bronchoscopy was performed in suspected or confirmed COVID-19 cases on MV for specific indications. Demographic, clinical, bronchoscopic and laboratory findings were analysed.

Results: 98 procedures were performed on 61 patients, mean age 62.1 years, 51 (83.6%) males. 42 patients (69%) had at least 1 co-morbidity. Major indications were new radiographic infiltrates with clinical deterioration, increased endotracheal tube (ETT) secretions and haemorrhagic secretions/hemoptysis. Common findings were copious secretions in 87 (88.8%), purulent in 61%, mucoid in 18%, haemorrhagic in 7% and frothy in 14% cases. On the management front, antibiotics were changed in 31 (31.6%) cases based on bronchoscopic findings. Other significant changes included reduction/stopping steroids and anticoagulation and ETT repositioning. The incidence of bacterial superinfection was high (54% culture positivity), a significant number (94%) with multi-drug resistant organisms. Fungi were seen in 7 cases (7.1%). Pneumocystis jiroveci was not seen and cytology did not show any viral inclusions. Therapeutic mucus plug removal was done in 30 cases (30.6%), and hemoptysis control in 4% cases. The procedures were safe and none of the HCW developed any COVID19 disease.

Conclusion: Bronchoscopy in critically ill MV COVID-19 patients contributes on both diagnostic and therapeutic fronts and impacts management decisions. With adequate precautions and standard protocols, it is safe for both HCW and patients.

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MEHTA, Ravindra et al. A study of the utility and safety of bronchoscopy in mechanically ventilated COVID19 ARDS: Transgressing the conventional guidelines. Medical Research Archives, [S.l.], v. 10, n. 1, jan. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2660>. Date accessed: 28 nov. 2022. doi: https://doi.org/10.18103/mra.v10i1.2660.
Research Articles


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