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Bronchoscopy During COVID-19: Reviewing an International Expert Panel Practice Statement

The second of Ambu’s four-part Bronchoscopy During COVID-19 webinar series features Dr. Angela Argento and Dr. Elizabeth Malsin discussing what they learned.

Two pulmonologists from Northwestern University, where more than 400 bronchoscopies have been performed on patients with known COVID-19 infections, detail how their institution has performed it safely and used it to save lives during the global coronavirus pandemic.

The second of Ambu’s four-part Bronchoscopy During COVID-19 webinar series features Dr. Angela Argento and Dr. Elizabeth Malsin discussing what they learned. The two also review a practice statement from an expert panel and compare their own experiences against the guidelines.

Dr. Argento is the director of interventional pulmonary at Northwestern University and Dr. Malsin is a pulmonary critical care specialist at Northwestern Memorial Hospital, the flagship hospital for Northwestern Medicine. Together, they discussedPerforming Bronchoscopy in Times of the COVID-19 Pandemic: Practice Statement from an International Expert Panel,” which was published in Respiration in April.

As an aerosol-generating procedure, bronchoscopy can put those performing it in harm’s way.

“I think it's hard sometimes with these statements to take the idea of what really is a clinical indication. It's something black and white on this statement, this piece of paper, but it's not that black and white in real life,” Dr. Malsin said.

Malsin said Northwestern was an “aggressive institution” in terms of deciding whether to go forward with a bronchoscopy. In the case of another coronavirus surge, she thinks they might be even more aggressive.

“There were so many times that I said this was actually explicitly helpful to either clinically clear secretions or to help make a diagnosis of a ventilator-associated or a concomitant infection that I would encourage myself and my colleagues to be as aggressive and to kind of keep up the hard work of doing the physical labor of bronching these people,” she said.

Dr. Argento and Dr. Malsin discussed how certain protocols developed locally at Northwestern differed from the guidelines. At Northwestern, bronchoscopy was done with only one or two experienced physicians in the room and kept as brief as possible. A nurse or respiratory therapist would stay outside of the room ready to assist if needed.

Ambu’s Bronchoscopy During COVID-19 webinar series is running through August 2020 and will be available for replay. Dr. Hudson Garrett is an international expert in infection prevention and control, infectious diseases, patient safety, and medical device safety and hygiene. His presentation, Protecting Patients and Healthcare Providers During Challenging Times: Evidence-Based Recommendations to Reduce Risks with Bronchoscopy,” is now available.

Russ Montgomery, the director of health economics and market access for North America at Ambu, will break down the financial aspects of switching to single-use endoscopy with Health Economics: Comparing the Costs of Reusable vs. Single-Use Bronchoscopes,” available starting Aug. 31.

In the first webinar in the series, Dr. James M. Horowitz discussed performing bronchoscopy in a New York City hospital during the pandemic’s early days and shared the lessons learned from his experiences.

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