Page 68 - ECBIP 2021_Program

6th European Congress ECBIP 15 - 17
Book of Abstracts
for Bronchology and
Interventional Pulmonology ATHENS - GREECE 2021
OCTOBER
PP38
MODERATED e-POSTER SESSION 06:
Infectious Diseases and COVID-19
BRONCHOSCOPY IN PATIENTS WITH COVID-19
David Barros Coelho1,2, Catarina Sousa1, Adriana Magalhães1
1 Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal 2 Faculdade de Medicina, Universidade do Porto, Porto, Portugal
Introduction: Although not indicated for diagnosis confirmation, bronchoscopy can be used to manage complications and obtain microbiological samples in patients with COVID-19. We aim to report our center experience with flexible bronchoscopy on patients with Sars-Cov-2 infection.
Methods: Bronchoscopies performed at Centro Hospitalar Universitário de São João between 1st March and 15th December were included. Bronchoscopists used personal protective equipment according to local guidelines at the Intensive Care Unit.Disposable scopes were used in all cases.All bronchoscopies included a description and appreciation by the performing bronchoscopist.
Results: A total of 36 bronchoscopies were performed on 15 different patients. The median number of bronchoscopies per patient was 2 (1-10). Indications for bronchoscopy were airway secretion management with/without atelectasis (n=28) , broncho-alveolar lavage due to suspected superinfection (n=4), hemoptysis (n=2), tracheal fistula suspicion (n= 1), foreign body aspiration (n= 1). Twenty-six (72.2%) bronchoscopies were done in patients with extracorporeal membrane oxygenation (ECMO). Two patients (13.3%) were not on mechanical ventilation. The volume of secretions was defined as abundant in 17 bronchoscopies (47.2%) and absent in 12 (33.3%).Thick mucous plugs were described in 9 cases, mainly in the lower segments. There were blood clots in 17 bronchoscopies (47.2%) – at the carina, trachea or both main bronchus (n=9), right main bronchus (n=2), middle lobe bronchus (n=2), lower segmental bronchus (n=4). Aspiration techniques included instillation of saline and use of small forceps. There was active bleeding in 8 and hyperemic friable mucosa in 13 procedures. In 2 of them cold saline, adrenaline and tranexamic acid instillation was needed for bleeding control. Bronchial wash or broncho-alveolar lavage were performed in 11 procedures - the most frequent microbiological agents identified were Klebsiella Pneumoniae (n=3) and Proteus mirabilis (n=2).There was a diagnosis of small-cell lung carcinoma in 1 patient due to bronchial brushing and biopsies. Median PaO2/FiO2 were 102 and 98 before and after the procedure. There was radiological improvement on the day after the procedure in 31.6% of cases (n=6) (see example in figure 1) and improvement in tidal volume in 50.0% (n=12). No bronchoscopist developed COVID-19 in the two weeks following the procedure.
Conclusion: Bronchoscopy can be used safely in selected patients for bronchial specimen collection and secretions aspiration in order to improve ventilation. It is also a safe method for the bronchoscopist as long as proper personal protective equipment is used.
Figure 1: Radiological evolution one day after bronchoscopy due to secretion management in a patient with atelectasis
68 6th European Congress for Bronchology and Interventional Pulmonology