1
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Mattson JR, Gada KD, Jawa R, Zhang X, Ahmad S. Impact of Humidification Modality on Incidence of Endotracheal Tube Occlusion in COVID-19 Patients. J Intensive Care Med 2024:8850666241246969. [PMID: 38634177 DOI: 10.1177/08850666241246969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background: Endotracheal tube (ETT) occlusion is reported at a higher frequency among coronavirus disease-2019 (COVID-19) patients. Prior to the COVID-19 pandemic, literature examining patient and ventilator characteristics, including humidification, as etiologies of ETT occlusion yielded mixed results. Our study examines the relationship of humidification modality with ETT occlusion in COVID-19 patients undergoing invasive mechanical ventilation (IMV). Methods: We conducted a retrospective chart review of COVID-19 patients requiring IMV at a tertiary care center in New York from April 2020 to April 2021. Teleflex Neptune heated wire heated humidification (HH) and hygroscopic Intersurgical FiltaTherm and Sunmed Ballard 1500 heat and moisture exchangers (HME) were used. Episodes of ETT occlusion were recorded. Univariate and multivariable logistic regression models were used to investigate the relationship between humidification modality and the occurrence of ETT occlusion. Findings: A total of 201 eligible patients were identified. Teleflex HH was utilized in 50.2% of the population and the others Intersurgical and Sunmed HME devices. Median age was 62 years and 78.6% of patients had at least one medical comorbidity. Precisely, 24% of patients experienced an ETT occlusion after a median of 12 days. The HME group was younger (58.5 vs 64 years), predominantly male (75% vs 59.4%), and experienced more total ventilator days than the HH group (24 vs 12). Those using the studied HME devices had significantly higher odds of ETT occlusion (OR 4.4, 95% CI 1.8-10.6, P = .0011). Three patients (6.1%) experienced cardiac arrest as a consequence of their occlusion. There were no deaths directly attributed to ETT occlusion. Conclusions: The studied HME devices were significantly associated with higher odds of ETT occlusion in COVID-19 patients requiring invasive mechanical ventilation. These events are not without significant clinical consequences. Prolonged use of under-performing HME devices remains suspect in the occurrence of ETT occlusions.
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Affiliation(s)
| | - Kunal Dhiren Gada
- Department of Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Randeep Jawa
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Xiaoyue Zhang
- Biostatistical Consulting Core, Department of Family, Population and Preventative Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Sahar Ahmad
- Department of Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
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2
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Houston SA, Gu Y, Vandemoortele T, Dumoulin E, Gillson AME, Tyan CC, Sakr L, Bendiak GN, Gonzalez AV, Fortin M. Bronchoscopy during the COVID-19 pandemic: A Canadian Thoracic Society Position Statement update. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2022. [DOI: 10.1080/24745332.2022.2137317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Simon A. Houston
- Division of Respirology, QEII-Halifax Infirmary, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yusing Gu
- Division of Respirology, QEII-Halifax Infirmary, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Thomas Vandemoortele
- Division of Respiratory Medicine, Department of Medicine, University of Montreal, Montreal, Québec, Canada
| | - Elaine Dumoulin
- Division of Respiratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ashley-Mae E. Gillson
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Chung-Chun Tyan
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lama Sakr
- Division of Respirology, Jewish General Hospital, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Glenda N. Bendiak
- Section of Respiratory Medicine, Alberta Children’s Hospital, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Anne V. Gonzalez
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Marc Fortin
- Division of Respirology, Institut universitaire de cardiologie et de pneumologie de Québec, Department of Medicine, Université Laval, Québec, Québec, Canada
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3
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Cumbo-Nacheli G, Colt H, Agrawal A, Cicenia J, Corbetta L, Goel AD, Goga A, Lee HJ, Murgu S, Pannu J, Senitko M, Tarantini F, Vujacich P, Williamson J, Yap E, Lentz RJ. Bronchoscopy in Patients With Known or Suspected COVID-19: Results From the Global Pandemic SARS-CoV-2 Bronchoscopy Database (GPS-BD). J Bronchology Interv Pulmonol 2022; 29:146-154. [PMID: 35318989 DOI: 10.1097/lbr.0000000000000805] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Amid the Coronavirus Disease 2019 (COVID-19) pandemic, the benefits and risks of bronchoscopy remain uncertain. This study was designed to characterize bronchoscopy-related practice patterns, diagnostic yields, and adverse events involving patients with known or suspected COVID-19. METHODS An online survey tool retrospectively queried bronchoscopists about their experiences with patients with known or suspected COVID-19 between March 20 and August 20, 2020. Collected data comprised the Global Pandemic SARS-CoV-2 Bronchoscopy Database (GPS-BD). All bronchoscopists and patients were anonymous with no direct investigator-to-respondent contact. RESULTS Bronchoscopy procedures involving 289 patients from 26 countries were analyzed. One-half of patients had known COVID-19. Most (82%) had at least 1 pre-existing comorbidity, 80% had at least 1 organ failure, 51% were critically ill, and 37% were intubated at the time of the procedure. Bronchoscopy was performed with diagnostic intent in 166 (57%) patients, yielding a diagnosis in 86 (52%). and management changes in 80 (48%). Bronchoscopy was performed with therapeutic intent in 71 (25%) patients, mostly for secretion clearance (87%). Complications attributed to bronchoscopy or significant clinical decline within 12 hours of the procedure occurred in 24 (8%) cases, with 1 death. CONCLUSION Results from this international database provide a widely generalizable characterization of the benefits and risks of bronchoscopy in patients with known or suspected COVID-19. Bronchoscopy in this setting has reasonable clinical benefit, with diagnosis and/or management change resulting from about half of the diagnostic cases. However, it is not without risk, especially in patients with limited physiological reserve.
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Affiliation(s)
- Gustavo Cumbo-Nacheli
- Spectrum Health, Michigan State University School of Human Medicine, Grand Rapids, MI
| | - Henri Colt
- University of California, Irvine Medical Center, Irvine, CA
| | - Abhinav Agrawal
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | | | | | - Akhil D Goel
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ameena Goga
- Steve Biko Academic Hospital, Praeteria, South Africa
| | | | | | | | - Michal Senitko
- University of Mississippi Medical Center School of Medicine, Jackson, MS
| | | | | | - Jonathan Williamson
- South West Clinical School, University of New South Wales
- MQ Health Respiratory and Sleep, Macquarie University, Sydney, Australia
| | - Elaine Yap
- Middlemore Hospital, Auckland, New Zealand
| | - Robert J Lentz
- Vanderbilt University Medical Center
- Department of Veterans Affairs Medical Center, Nashville, TN
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4
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Saha BK, Saha S, Chong WH, Beegle S. Indications, Clinical Utility, and Safety of Bronchoscopy in COVID-19. Respir Care 2022; 67:241-251. [PMID: 34848547 PMCID: PMC9993945 DOI: 10.4187/respcare.09405] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Bronchoscopy is an aerosol-generating procedure and routine use for patients with coronavirus disease 2019 (COVID-19) has been discouraged. The purpose of this review was to discuss the indications, clinical utility, and risks associated with bronchoscopy in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. METHODS A literature search was performed by using appropriate key terms to identify all relevant articles from medical literature databases up to August 1, 2021. RESULTS Twelve cohorts (9 retrospective and 3 prospective) reported the performance of 2,245 bronchoscopies in 1,345 patients with COVID-19. The majority of the subjects were male. Nearly two thirds of the bronchoscopies (62%) were performed for therapeutic indications; the rest (38%) were for diagnostic purposes. Bronchoalveolar lavage had an overall yield of 33.1% for SARS-CoV-2 in subjects with negative results of real-time polymerase chain reaction on nasopharyngeal specimens. The incidence of a secondary infection ranged from 9.3% to as high as 65%. Antibiotics were changed in a significant number of the subjects (14%-83%) based on the bronchoscopic findings. Bronchoscopy was well tolerated in most subjects except those who required noninvasive ventilation, in whom the intubation rate after the procedure was 60%. The rate of transmission of SARS-CoV-2 among health-care workers was minimum. CONCLUSIONS Bronchoscopy in patients with COVID-19 results in a significant change in patient management. Transmission of SARS-CoV-2 seems to be low with consistent use of appropriate personal protective equipment by health-care workers. Therefore, bronchoscopic evaluation should be considered for all diagnostic and therapeutic indications in this patient population.
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Affiliation(s)
- Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri.
| | - Santu Saha
- Division of Internal Medicine, Bangladesh Medical College, Dhaka, Bangladesh
| | - Woon H Chong
- Division of Pulmonary and Critical Care Medicine, Albany Medical Center College, Albany, New York
| | - Scott Beegle
- Division of Pulmonary and Critical Care Medicine, Albany Medical Center College, Albany, New York
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5
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Mehta R, Bansal S, Kalpakam H, Kumar A, Varsha A, Thorbole A. Lower respiratory tract sampling in COVID-19 acute respiratory distress syndrome: A focus on microbiology, cellular morphology, cytology, and management impact. Lung India 2022; 39:139-144. [PMID: 35259796 PMCID: PMC9053917 DOI: 10.4103/lungindia.lungindia_532_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Methods: Results: Conclusions:
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6
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Muljono CG, Marhana IA, Syafaah I, Setiawan HW, Semedi BP, Abbas KA. Increase of lung function usage bronchoscopy in COVID-19 patients: Three case series in Indonesian adult. Int J Surg Case Rep 2021; 89:106623. [PMID: 34826747 PMCID: PMC8609668 DOI: 10.1016/j.ijscr.2021.106623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 12/01/2022] Open
Abstract
Background COVID-19 is a virus that is spread by aerosol which can cause worsening of hypoxia and bronchoscopy procedures in COVID-19 patients may be considered. Method The design of this study is a case series reported using the Preferred Reporting of Case Series in Surgery (PROCESS) 2020 Guideline. Data collection was carried out in the period January–April 2021. All participants underwent X-ray examination and blood gas analysis as well as signs of infection before and after bronchoscopy. Result Three intubated patients with COVID-19 were confirmed from PCR nasopharyngeal swab present with worsening on chest X-ray. All three patients had a normal bronchial wall with some inflammation and thick mucus resulting in lung atelectasis and massive inhomogeneous opacity on chest X-ray. Patients showed improvement on chest X-ray after bronchoscopy intervention. Conclusion The bronchoscopy procedure can improve the lung function of COVID-19 patients and if it is carried out by medical personnel who pay attention to universal precautions, it will minimize the occurrence of transmission. Bronchoscopy procedure improves lung function in COVID-19 patients. The use of additional personal protective equipment for medical personnel is required during bronchoscopy in COVID-19 patients. Bronchoscopy can prevent the use of antibiotics that are not effective.
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Affiliation(s)
- Christa Graziella Muljono
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Isnin Anang Marhana
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
| | - Irmi Syafaah
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Herley Windo Setiawan
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Bambang Pujo Semedi
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Kun Arifi Abbas
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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7
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Pozzi N, Zuckerman A, Son J, Geraci TC, Chang SH, Cerfolio RJ. Managing Scarcity: Innovation and Resilience During the COVID-19 Pandemic. Front Surg 2021; 8:769962. [PMID: 34722628 PMCID: PMC8551480 DOI: 10.3389/fsurg.2021.769962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 01/30/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic remains a disruptive force upon the health care system, with particular import for thoracic surgery given the pulmonary pathophysiology and disease implications of the virus. The rapid and severe onset of disease required expedient innovation and change in patient management and novel approaches to care delivery and nimbleness of workforce. In this review, we detail our approaches to patients with COVID-19, including those that required surgical intervention, our expedited and novel approach to bronchoscopy and tracheostomy, and our expansion of telehealth. The pandemic has created a unique opportunity to reflect on our delivery of care in thoracic surgery and apply lessons learned during this time to "rethink" how to optimize resources and deliver excellent and cutting-edge patient care.
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Affiliation(s)
- Natalie Pozzi
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
| | - Aaron Zuckerman
- Department of General Surgery, NYU Langone Health-Brooklyn, Brooklyn, NY, United States
| | - Joohee Son
- Department of General Surgery, NYU Langone Health-Brooklyn, Brooklyn, NY, United States
| | - Travis C Geraci
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
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8
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Patrucco F, Failla G, Ferrari G, Galasso T, Candoli P, Mondoni M, Piro R, Facciolongo NC, Renda T, Salio M, Scala R, Solidoro P, Mattei A, Donato P, Vaschetto R, Balbo PE. Bronchoscopy during COVID-19 pandemic, ventilatory strategies and procedure measures. Panminerva Med 2021; 63:529-538. [PMID: 34606187 DOI: 10.23736/s0031-0808.21.04533-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has changed bronchoscopy practices worldwide. Bronchoscopy is a high-risk aerosol-generating procedure with a potential for direct SARS-CoV-2 exposure and hospital-acquired infection. Current guidelines about personal protective equipment and environment considerations represent key competencies to minimize droplets dispersion and reduce the risk of transmission. Different measures should be put in field based on setting, patient's clinical characteristics, urgency and indications of bronchoscopy. The use of this technique in SARS-CoV-2 patients is reported primarily for removal of airway plugs and for obtaining microbiological culture samples. In mechanically ventilated patients with SARS-CoV-2, bronchoscopy is commonly used to manage complications such as hemoptysis, atelectasis or lung collapse when prone positioning, physiotherapy or recruitment maneuvers have failed. Further indications are represented by assistance during percutaneous tracheostomy. Continuous positive airway pressure, non-invasive ventilation support and high flow nasal cannula oxygen are frequently used in patient affected by Coronavirus Disease-2019 (COVID-19): management of patients' airways and ventilation strategies differs from bronchoscopy indications, patient's clinical status and in course or required ventilatory support. Sedation is usually administered by the pulmonologist (performing the bronchoscopy) or by the anesthetist depending on the complexity of the procedure and the level of sedation required. Finally, elective bronchoscopy for diagnostic indications during COVID-19 pandemic should be carried on respecting rigid standards which allow to minimize potential viral transmission, independently from patient's COVID-19 status. This narrative review aims to evaluate the indications, procedural measures and ventilatory strategies of bronchoscopy performed in different settings during COVID-19 pandemic.
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Affiliation(s)
- Filippo Patrucco
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità, Novara, Italy - .,Translational Medicine Department, University of Eastern Piedmont, Novara, Italy -
| | - Giuseppe Failla
- Interventional Pneumology Unit, Onco-Haematologic and Pneumo-Haematolgoic Department, AORN A. Cardarelli, Napoli, Italy.,Diagnostic and Therapeutic Bronchoscopy Unit, ARNAS Civico e Benfratelli, Palermo, Italy
| | - Giovanni Ferrari
- Pulmonology and Semi-Intensive Respiratory Units, Medical Department, AO Mauriziano, Torino, Italy
| | - Thomas Galasso
- Interventional Pneumology Unit, Thoraco-Cardio-Vascular Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Piero Candoli
- Interventional Pneumology Unit, Thoraco-Cardio-Vascular Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Michele Mondoni
- Pulmonology Unit, Cardio-Respiratory Department, Ospedale San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Roberto Piro
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Nicola C Facciolongo
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Teresa Renda
- Pneumology and Thoraco-Pulmonary Physiopathology Unit, Cardio-Thoraco-Vascular Department, Careggi Hospital, Firenze, Italy
| | - Mario Salio
- Respiratory Diseases Unit, Internistic Department, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Raffaele Scala
- Pneumology Unit, Cardio-Thoraco-Neuro-Vascular Department, San Donato Hospital, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - Paolo Solidoro
- Pneumology Unit, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza, Torino, Italy.,Medical Sciences Department, University of Turin, Italy
| | - Alessio Mattei
- Pneumology Unit, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza, Torino, Italy
| | - Paolo Donato
- Intensive Care Unit 1, Emergency Department, AOU Maggiore della Carità, Novara, Italy
| | - Rosanna Vaschetto
- Translational Medicine Department, University of Eastern Piedmont, Novara, Italy.,Intensive Care Unit 1, Emergency Department, AOU Maggiore della Carità, Novara, Italy
| | - Piero E Balbo
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità, Novara, Italy
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9
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Abstract
Bronchoscopy is a safe and commonly performed procedure for diagnostic as well as therapeutic indications. Bronchoscopy is also an aerosol-generating procedure, and due to the risk of severe acute respiratory syndrome coronavirus 2 transmission during the procedure, routine bronchoscopy has been discouraged by multiple professional societies, despite any solid evidence. There are only a few reports of bronchoscopy in patients with coronavirus disease 2019 in the literature. Bronchoscopy in this patient population plays a crucial role not only in the diagnosis of coronavirus disease 2019 but also in the identification of secondary bacterial or fungal infections and in directing appropriate antimicrobial therapy. Bronchoscopy with therapeutic interventions may be lifesaving. Based on the literature, the risk of coronavirus disease 2019 transmission appears to be low among bronchoscopists and other healthcare workers when appropriate personal protective equipment is used. Bronchoscopy in patients with coronavirus disease 2019 should be strongly considered when clinically indicated.
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10
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Volpe MS, Guimarães FS. Secretion Removal in Deeply Sedated Mechanically Ventilated Subjects - Time for Implementation! Respir Care 2021; 66:1495-1497. [PMID: 34408083 PMCID: PMC9993882 DOI: 10.4187/respcare.09309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Marcia S Volpe
- Department of Sciences of Human Movement Federal University of São PauloSão Paulo, Brazil
| | - Fernando S Guimarães
- Physical Therapy DepartmentFederal University of Rio de JaneiroRio de Janeiro, Brazil
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11
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Saha BK, Chenna P. Risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during bronchoscopy in the intensive care unit. Respirology 2021; 26:910-913. [PMID: 34387393 PMCID: PMC8447479 DOI: 10.1111/resp.14131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri, USA
| | - Praveen Chenna
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
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12
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Kvietys PR, Fakhoury HMA, Kadan S, Yaqinuddin A, Al-Mutairy E, Al-Kattan K. COVID-19: Lung-Centric Immunothrombosis. Front Cell Infect Microbiol 2021; 11:679878. [PMID: 34178722 PMCID: PMC8226089 DOI: 10.3389/fcimb.2021.679878] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
The respiratory tract is the major site of infection by SARS-CoV-2, the virus causing COVID-19. The pulmonary infection can lead to acute respiratory distress syndrome (ARDS) and ultimately, death. An excessive innate immune response plays a major role in the development of ARDS in COVID-19 patients. In this scenario, activation of lung epithelia and resident macrophages by the virus results in local cytokine production and recruitment of neutrophils. Activated neutrophils extrude a web of DNA-based cytoplasmic material containing antimicrobials referred to as neutrophil extracellular traps (NETs). While NETs are a defensive strategy against invading microbes, they can also serve as a nidus for accumulation of activated platelets and coagulation factors, forming thrombi. This immunothrombosis can result in occlusion of blood vessels leading to ischemic damage. Herein we address evidence in favor of a lung-centric immunothrombosis and suggest a lung-centric therapeutic approach to the ARDS of COVID-19.
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Affiliation(s)
| | | | - Sana Kadan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Eid Al-Mutairy
- Department of Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia
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13
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Díez-Ferrer M, Martin-Cabeza C, Cubero N, Sabater-Riera J, Santos S, López-Lisbona RM. Role of bronchoscopy in critically ill patients with COVID-19 pneumonia. Rev Clin Esp 2021; 221:430-431. [PMID: 34103278 PMCID: PMC8179621 DOI: 10.1016/j.rceng.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/20/2020] [Indexed: 11/27/2022]
Affiliation(s)
- M Díez-Ferrer
- Servicio de Neumología, Hospital Universitario de Bellvitge - IDIBELL - Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - C Martin-Cabeza
- Servicio de Neumología, Hospital Universitario de Bellvitge - IDIBELL - Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - N Cubero
- Servicio de Neumología, Hospital Universitario de Bellvitge - IDIBELL - Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Sabater-Riera
- Servicio de Medicina Intensiva, Hospital Universitario de Bellvitge - IDIBELL - Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Santos
- Servicio de Neumología, Hospital Universitario de Bellvitge - IDIBELL - Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - R M López-Lisbona
- Servicio de Neumología, Hospital Universitario de Bellvitge - IDIBELL - Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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14
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Barron S, Kennedy MP. Can single-use bronchoscopes help prevent nosocomial COVID-19 infections? Expert Rev Med Devices 2021; 18:439-443. [PMID: 33891519 DOI: 10.1080/17434440.2021.1920924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: The reduction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission has been achieved through numerous public health initiatives worldwide. In the hospital environment, certain high-risk procedures have the potential to cause transmission of the virus to health-care workers and nosocomial transmission to patients through different mechanisms including the generation of aerosols and fomite formation via contamination of medical devices.Areas covered: Aerosol-generating procedures such as bronchoscopy are considered high risk for SARS-CoV-2 transmission. As a result, single-use devices should be used where possible and changing to single-use flexible bronchoscopes has been advised by respiratory societies internationally. In this paper, we outline the rationale for this advice and have analyzed the evidence relating to the reduction in SARS-CoV-2 transmission arising from a switch to these single-use devices and the potential impact that this switch may have on the quality of pulmonology services.Expert opinion: In this paper, we outline the rationale for this advice and have analyzed the evidence relating to the reduction in SARS-CoV-2 transmission arising from a switch to these single-use devices and the potential impact that this switch may have on the quality of pulmonology services.
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Affiliation(s)
- Sarah Barron
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Marcus Peter Kennedy
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,ASSERT Centre, University College Cork, Cork, Ireland.,College of Medicine and Health, University College Cork, Cork, Ireland
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15
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Bronchoalveolar Lavage in Patients with COVID-19 with Invasive Mechanical Ventilation for Acute Respiratory Distress Syndrome. Ann Am Thorac Soc 2021; 18:723-726. [PMID: 33233944 PMCID: PMC8009009 DOI: 10.1513/annalsats.202007-868rl] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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16
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Sampsonas F, Kakoullis L, Karampitsakos T, Papaioannou O, Katsaras M, Papachristodoulou E, Kyriakou G, Bellou A, Tzouvelekis A. Bronchoscopy during the COVID-19 pandemic: effect on current practices and strategies to reduce procedure-associated transmission. Expert Rev Respir Med 2021; 15:773-779. [PMID: 33798401 DOI: 10.1080/17476348.2021.1913058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Bronchoscopy and related procedures have unambiguously been affected during the Corona Virus Disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS COV-2). Ordinary bronchoscopy practices and lung cancer services might have changed over this pandemic and for the years to come.Areas covered: This manuscript summarizes the utility of bronchoscopy in COVID-19 patients, and the impact of the pandemic in lung cancer diagnostic services, in view of possible viral spread during these We conducted a literature review of articles published in PubMed/Medline from inception to November 5th, 2020 using relevant terms.Expert opinion: Without doubt this pandemic has changed the way bronchoscopy and related procedures are being performed. Mandatory universal personal protective equipment, pre-bronchoscopy PCR tests, dedicated protective barriers and disposable bronchoscopes might be the safest and simpler way to perform even the most complicated procedures.
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Affiliation(s)
- Fotios Sampsonas
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
| | - Loukas Kakoullis
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
| | - Theodoros Karampitsakos
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
| | - Ourania Papaioannou
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
| | - Matthaios Katsaras
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
| | | | | | - Aggeliki Bellou
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
| | - Argyrios Tzouvelekis
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
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17
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Eber E, Goussard P. Bronchoscopy precautions and recommendations in the COVID-19 pandemic. Paediatr Respir Rev 2021; 37:68-73. [PMID: 33583721 PMCID: PMC7843245 DOI: 10.1016/j.prrv.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 12/23/2022]
Abstract
As the airways of SARS-CoV-2 infected patients contain a high viral load, bronchoscopy is associated with increased risk of patient to health care worker transmission due to aerosolised viral particles and contamination of surfaces during bronchoscopy. Bronchoscopy is not appropriate for diagnosing SARS-CoV-2 infection and, as an aerosol generating procedure involving a significant risk of transmission, has a very limited role in the management of SARS-CoV-2 infected patients including children. During the SARS-CoV-2 pandemic rigid bronchoscopy should be avoided due to the increased risk of droplet spread. Flexible bronchoscopy should be performed first in SARS-CoV-2 positive individuals or in unknown cases, to determine if rigid bronchoscopy is indicated. When available single-use flexible bronchoscopes may be considered for use; devices are available with a range of diameters, and improved image quality and degrees of angulation. When rigid bronchoscopy is necessary, jet ventilation must be avoided and conventional ventilation be used to reduce the risk of aerosolisation. Adequate personal protection equipment is key, as is training of health care workers in correct donning and doffing. Modified full face masks are a practical and safe alternative to filtering facepieces for use in bronchoscopy. When anaesthetic and infection prevention control protocols are strictly adhered to, bronchoscopy can be performed in SARS-CoV-2 positive children.
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Affiliation(s)
- Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, A-8036 Graz, Austria
| | - Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
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18
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19
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Wiles S, Mireles-Cabodevila E, Neuhofs S, Mukhopadhyay S, Reynolds JP, Hatipoğlu U. Endotracheal Tube Obstruction Among Patients Mechanically Ventilated for ARDS Due to COVID-19: A Case Series. J Intensive Care Med 2020; 36:604-611. [PMID: 33375893 DOI: 10.1177/0885066620981891] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with COVID-19 and ARDS on prolonged mechanical ventilation are at risk for developing endotracheal tube (ETT) obstruction that has not been previously described in patients with ARDS due to other causes. The purpose of this report is to describe a case series of patients with COVID-19 and ARDS in which ETT occlusion resulted in significant clinical consequences and to define the pathology of the obstructing material. METHODS Incidents of ETT occlusion during mechanical ventilation of COVID-19 patients were reported by clinicians and retrospective chart review was conducted. Statistical analysis was performed comparing event rates between COVID-19 and non-COVID 19 patients on mechanical ventilation over the predefined period. Specimens were collected and submitted for pathological examination. FINDINGS Eleven COVID-19 patients experienced endotracheal tube occlusion over a period of 2 months. Average age was 69 (14.3, range 33-85) years. Mean APACHE III score was 73.6 (17.3). All patients had AKI and cytokine storm. Nine exhibited biomarkers for hypercoagulability. Average days on mechanical ventilation before intervention for ETT occlusion was 14 (5.18) days (range of 9 to 23 days). Five patients were discharged from the ICU, and 4 expired. Average documented airway resistance on admission was 14.2 (3.0) cm H2O/L/sec. Airway resistance before tube exchange was 28.1 (8.0) cm H2O /L/sec. No similar events of endotracheal tube occlusion were identified in non-COVID patients on mechanical ventilation during the same time period. Microscopically, the material consisted of mucin admixed with necrotic cell debris, variable numbers of degenerated inflammatory cells, oral contaminants and red blood cells. INTERPRETATION Patients with COVID-19 and ARDS on prolonged mechanical ventilation are at risk for developing ETT obstruction due to deposition of a thick, tenacious material within the tube that consists primarily of mucin and cellular debris. Clinicians should be aware of this dangerous but treatable complication.
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Affiliation(s)
- Samuel Wiles
- Department of Pulmonary/Critical Care, Respiratory Institute, 2569Cleveland Clinic, OH, USA
| | | | - Scott Neuhofs
- Department of Pulmonary/Critical Care, Respiratory Institute, 2569Cleveland Clinic, OH, USA
| | - Sanjay Mukhopadhyay
- Department of Pathology, Pathology and Laboratory Medicine Institute, 2569Cleveland Clinic Foundation, OH, USA
| | - Jordan P Reynolds
- Department of Pathology, Pathology and Laboratory Medicine Institute, 2569Cleveland Clinic Foundation, OH, USA
| | - Umur Hatipoğlu
- Department of Pulmonary/Critical Care, Respiratory Institute, 2569Cleveland Clinic, OH, USA
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20
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Bruyneel M, Gabrovska M, Rummens P, Roman A, Claus M, Stevens E, Dechamps P, Demey L, Truffaut L, Ninane V. Bronchoscopy in COVID-19 intensive care unit patients. Respirology 2020; 25:1313-1315. [PMID: 32844524 PMCID: PMC7460941 DOI: 10.1111/resp.13932] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Marie Bruyneel
- Department of Pneumology, CHU Saint-Pierre, Brussels, Belgium.,Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Gabrovska
- Department of Pneumology, CHU Saint-Pierre, Brussels, Belgium.,Université Libre de Bruxelles, Brussels, Belgium
| | - Peter Rummens
- Department of Pneumology, CHU Saint-Pierre, Brussels, Belgium.,Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Roman
- Université Libre de Bruxelles, Brussels, Belgium.,Department of Intensive Care Medicine, CHU Saint-Pierre, Brussels, Belgium
| | - Marc Claus
- Université Libre de Bruxelles, Brussels, Belgium.,Department of Intensive Care Medicine, CHU Saint-Pierre, Brussels, Belgium
| | - Etienne Stevens
- Université Libre de Bruxelles, Brussels, Belgium.,Department of Intensive Care Medicine, CHU Saint-Pierre, Brussels, Belgium
| | - Philippe Dechamps
- Université Libre de Bruxelles, Brussels, Belgium.,Department of Intensive Care Medicine, CHU Saint-Pierre, Brussels, Belgium
| | - Lucas Demey
- Department of Pneumology, CHU Saint-Pierre, Brussels, Belgium.,Université Libre de Bruxelles, Brussels, Belgium
| | - Laurent Truffaut
- Department of Pneumology, CHU Saint-Pierre, Brussels, Belgium.,Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Ninane
- Department of Pneumology, CHU Saint-Pierre, Brussels, Belgium.,Université Libre de Bruxelles, Brussels, Belgium
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