Preventing Infection

Study: Precautions Allow for Safe Bronchoscopy in Pandemic

Initial concerns about the safety of bronchoscopy in COVID-19 patients overestimate the risk of provider infection, and our results are reassuring to the bronchoscopist community.

New research shows the risk of infection from bronchoscopy procedures during the ongoing global novel coronavirus pandemic is low when careful precautions are used.

Safety protocol followed by the researchers included using single-use bronchoscopes.

A recent Northwestern University Feinberg School of Medicine study, based on more than 450 COVID-19 bronchoalveolar lavage (BAL) procedures on more than 280 ventilated COVID-19 patients, shows that none of the hospital’s providers involved in the care developed COVID-19 and only one had a positive blood test.

“Professional society guidelines cautioning against bronchoscopy for COVID-19 patients are only based on expert opinion,” Catherina A. Gao, Joseph I. Bailey and other study authors write. “Initial concerns about the safety of bronchoscopy in COVID-19 patients overestimate the risk of provider infection, and our results are reassuring to the bronchoscopist community.”

Concern that bronchoscopy would expose healthcare workers to COVID-19 by generating aerosols initially prompted the American Association for Bronchology and Interventional Pulmonology (AABIP) to discourage bronchoscopy in patients with the virus. That concern also inspired international guidelines calling for the use of single-use scopes when the procedure was deemed necessary.

The standard in the Northwestern ICU for both clinical and research purposes is to do BAL with quantitative cultures, according to the study.

During the study, nurses and respiratory therapists were not in the rooms during the actual bronchoscopies. PPE included an N95 mask, eye protection, gloves, gown, and hair protection. Bronchoscopy was performed with a disposable Ambu® aScope™ Broncho.

Forty-five of the 52 clinical pulmonary and critical care faculty agreed to participate in the study. Of those, 42 percent spent more than five weeks in COVID-19 ICU service.

The hospital’s protocol included:

  • Limiting number of healthcare workers in the room
  • Minimizing aerosol generation by clamping the endotracheal tube and disconnecting the inspiratory limb of the ventilator during manipulations
  • Minimizing cough by neuromuscular blockade or heavy sedation and instillation of lidocaine into the tracheobronchial tree
  • Use of a disposable bronchoscope

One study limitation disclosed by its authors is it was retrospective, based on the recollection of the providers. Voluntary responses were used rather than electronic medical records, to protect the privacy of study participants.

Also, despite testing being offered to all providers, only a subset was actually tested, and so the results may underrepresent the true infection risk, the authors say. Asymptomatic infections also may have been missed if providers did not seek testing shortly after performing the BALs.

“While additional research is needed to inform optimal use of BAL to improve outcomes for ventilated COVID-19 patients, our data suggest that careful, protocolled BAL routinely incorporated into COVID-19 patient ICU care offers minimal infectious risk to providers,” the authors write.

Click here for a webinar sponsored by Ambu Inc. featuring Northwestern doctors discussing the COVID-19 expert panel guidelines and their experiences during the pandemic.

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