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

Main Article Content

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

Abstract

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.

Article Details

How to Cite
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.
Section
Research Articles

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