tetano
Editor, Senior Moderator
ERJ Open Res
. 2021 Jul 12;7(3):00165-2021.
doi: 10.1183/23120541.00165-2021. eCollection 2021 Jul.
The role of bronchoscopy in patients with SARS-CoV-2 pneumonia
Marisol Arenas-De Larriva[SUP] 1 [/SUP], Roberto Martín-DeLeon[SUP] 2 [/SUP], Blanca Urrutia Royo[SUP] 3 [/SUP], Iker Fernández-Navamuel[SUP] 4 [/SUP], Andrés Gimenez Velando[SUP] 4 [/SUP], Laura Nuñez García[SUP] 4 [/SUP], Carmen Centeno Clemente[SUP] 5 [/SUP], Felipe Andreo García[SUP] 5 [/SUP], Albert Rafecas Codern[SUP] 6 [/SUP], Carmen Fernández-Arias[SUP] 6 [/SUP], Virginia Pajares Ruiz[SUP] 6 [/SUP], Alfons Torrego Fernández[SUP] 6 [/SUP], Olga Rajas[SUP] 7 [/SUP], Gorane Iturricastillo[SUP] 8 [/SUP], Ricardo Garcia Lujan[SUP] 9 [/SUP], Lorena Comeche Casanova[SUP] 10 [/SUP], Albert Sánchez-Font[SUP] 11 [/SUP], Ricardo Aguilar-Colindres[SUP] 12 [/SUP], Roberto Larrosa-Barrero[SUP] 13 [/SUP], Ruth García García[SUP] 14 [/SUP], Rosa Cordovilla[SUP] 14 [/SUP], Ana Núñez-Ares[SUP] 15 [/SUP], Andrés Briones-Gómez[SUP] 16 [/SUP], Enrique Cases Viedma[SUP] 16 [/SUP], José Franco[SUP] 17 [/SUP], Javier Cosano Povedano[SUP] 18 [/SUP], Manuel Luis Rodríguez-Perálvarez[SUP] 19 [/SUP], Jose Joaquin Cebrian Gallardo[SUP] 20 [/SUP], Manuel Nuñez Delgado[SUP] 21 [/SUP], María Pavón-Masa[SUP] 22 [/SUP], Maria Del Mar Valdivia Salas[SUP] 23 [/SUP], Javier Flandes[SUP] 24 [/SUP]
Affiliations
Abstract
Background: The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate.
Patients and methods: This observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression.
Results: A total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR 1.60; p=0.041), absence of mucosal hyperaemia (OR 0.49; p=0.041) and the presence of haematic secretions (OR 1.79; p=0.032).
Conclusion: Bronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19.
. 2021 Jul 12;7(3):00165-2021.
doi: 10.1183/23120541.00165-2021. eCollection 2021 Jul.
The role of bronchoscopy in patients with SARS-CoV-2 pneumonia
Marisol Arenas-De Larriva[SUP] 1 [/SUP], Roberto Martín-DeLeon[SUP] 2 [/SUP], Blanca Urrutia Royo[SUP] 3 [/SUP], Iker Fernández-Navamuel[SUP] 4 [/SUP], Andrés Gimenez Velando[SUP] 4 [/SUP], Laura Nuñez García[SUP] 4 [/SUP], Carmen Centeno Clemente[SUP] 5 [/SUP], Felipe Andreo García[SUP] 5 [/SUP], Albert Rafecas Codern[SUP] 6 [/SUP], Carmen Fernández-Arias[SUP] 6 [/SUP], Virginia Pajares Ruiz[SUP] 6 [/SUP], Alfons Torrego Fernández[SUP] 6 [/SUP], Olga Rajas[SUP] 7 [/SUP], Gorane Iturricastillo[SUP] 8 [/SUP], Ricardo Garcia Lujan[SUP] 9 [/SUP], Lorena Comeche Casanova[SUP] 10 [/SUP], Albert Sánchez-Font[SUP] 11 [/SUP], Ricardo Aguilar-Colindres[SUP] 12 [/SUP], Roberto Larrosa-Barrero[SUP] 13 [/SUP], Ruth García García[SUP] 14 [/SUP], Rosa Cordovilla[SUP] 14 [/SUP], Ana Núñez-Ares[SUP] 15 [/SUP], Andrés Briones-Gómez[SUP] 16 [/SUP], Enrique Cases Viedma[SUP] 16 [/SUP], José Franco[SUP] 17 [/SUP], Javier Cosano Povedano[SUP] 18 [/SUP], Manuel Luis Rodríguez-Perálvarez[SUP] 19 [/SUP], Jose Joaquin Cebrian Gallardo[SUP] 20 [/SUP], Manuel Nuñez Delgado[SUP] 21 [/SUP], María Pavón-Masa[SUP] 22 [/SUP], Maria Del Mar Valdivia Salas[SUP] 23 [/SUP], Javier Flandes[SUP] 24 [/SUP]
Affiliations
- PMID: 34258257
- PMCID: PMC8183029
- DOI: 10.1183/23120541.00165-2021
Abstract
Background: The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate.
Patients and methods: This observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression.
Results: A total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR 1.60; p=0.041), absence of mucosal hyperaemia (OR 0.49; p=0.041) and the presence of haematic secretions (OR 1.79; p=0.032).
Conclusion: Bronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19.