A study out of Indonesia has shown the value of bronchoscopy in improving lung function in COVID-19 patients and in preventing the use of ineffective antibiotics.
“Urgent life-saving bronchoscopy can be performed with the expectation that it would significantly affect the patient's clinical prognosis,” according to a case series authored by Dr. Christa Graziella Muljono and others published this month in the International Journal of Surgery Case Reports.
The research was based on data collected between January and April 2021 at Dr. Soetomo General Academic Hospital in Surabaya, Indonesia. In the study, three intubated patients with COVID-19 showed improvement on chest x-rays after bronchoscopy intervention.
Early on in the global pandemic, bronchoscopies all but stopped worldwide over fears of the aerosols they potentially spread and risk of transmission to healthcare workers and other patients. Medical personnel have close contact with the patient during a bronchoscopy, and coughing and suctioning can generate large numbers of both aerosols and droplets known to transmit infection.
But doctors quickly found ways to perform bronchoscopies safely, using additional personal protective equipment (PPE) and taking a variety of other precautions.
In March 2020, the American Association for Bronchology and Interventional Pulmonology (AABIP) recommended that physicians not perform bronchoscopies on patients suspected or confirmed to have COVID-19. If bronchoscopy was warranted during COVID-19 testing or treatment, AABIP said “disposable bronchoscopes should be used first line when available.”
National and international task forces and societies added to the chorus advocating for single-use bronchoscopes when bronchoscopies needed to be done.
“Bronchoscopy in COVID-19 patients is still a matter of debate, but if airway complications … occur in COVID-19 patients, the bronchoscopy procedure must be carried out immediately,” the authors of the Indonesian study write.
The researchers also say that although the exact efficacy of bronchoscopy in COVID-19 has not been published, it has been shown to increase lung capacity in patients more than 50 years old.
It was reported that 30 percent of COVID-19 patients in the ICU underwent bronchoalveolar lavage (BAL) and worsening hypoxia. Bronchoscopy can be used to prevent the use of antibiotics that are not effective, the researchers say.
Now two years into a global pandemic that has claimed more than 5 million lives — nearly 800,000 in the U.S. — and with the new Omicron variant just identified, single-use bronchoscopes and sterile, leak-proof containers for BAL samples remain among the best safeguards when doing bronchoscopy.