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Bartolini A, Morecchiato F, Antonelli A, Malentacchi F, Rossolini GM, Pollini S. Evaluation of STANDARD™ M10 SARS-CoV-2 from bronchoalveolar lavage samples. Diagn Microbiol Infect Dis 2024; 110:116466. [PMID: 39128208 DOI: 10.1016/j.diagmicrobio.2024.116466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/08/2024] [Accepted: 07/22/2024] [Indexed: 08/13/2024]
Abstract
Detection of SARS-CoV-2 in bronchoalveolar lavage (BAL) is considered as a promising alternative method to detect COVID-19 infection. STANDARD™ M10 SARS-CoV-2 assay on 150 negative and 50 positives BAL samples for SARS-CoV-2 showed 96 % sensitivity, 100 % specificity compared to Allplex™ SARS-CoV-2 assay and a 31.25 genomic copies/mL limit of detection.
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Affiliation(s)
- Andrea Bartolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Fabio Morecchiato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy; NARR Joint Laboratory for antimicrobial resistance research and control, University of Florence-IRCCS Don Gnocchi Foundation, Florence, Italy
| | | | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy; NARR Joint Laboratory for antimicrobial resistance research and control, University of Florence-IRCCS Don Gnocchi Foundation, Florence, Italy
| | - Simona Pollini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy; NARR Joint Laboratory for antimicrobial resistance research and control, University of Florence-IRCCS Don Gnocchi Foundation, Florence, Italy.
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2
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Tomassetti S, Ciani L, Luzzi V, Gori L, Trigiani M, Giuntoli L, Lavorini F, Poletti V, Ravaglia C, Torrego A, Maldonado F, Lentz R, Annunziato F, Maggi L, Rossolini GM, Pollini S, Para O, Ciurleo G, Casini A, Rasero L, Bartoloni A, Spinicci M, Munavvar M, Gasparini S, Comin C, Cerinic MM, Peired A, Henket M, Ernst B, Louis R, Corhay JL, Nardi C, Guiot J. Utility of bronchoalveolar lavage for COVID-19: a perspective from the Dragon consortium. Front Med (Lausanne) 2024; 11:1259570. [PMID: 38371516 PMCID: PMC10869531 DOI: 10.3389/fmed.2024.1259570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/09/2024] [Indexed: 02/20/2024] Open
Abstract
Diagnosing COVID-19 and treating its complications remains a challenge. This review reflects the perspective of some of the Dragon (IMI 2-call 21, #101005122) research consortium collaborators on the utility of bronchoalveolar lavage (BAL) in COVID-19. BAL has been proposed as a potentially useful diagnostic tool to increase COVID-19 diagnosis sensitivity. In both critically ill and non-critically ill COVID-19 patients, BAL has a relevant role in detecting other infections or supporting alternative diagnoses and can change management decisions in up to two-thirds of patients. BAL is used to guide steroid and immunosuppressive treatment and to narrow or discontinue antibiotic treatment, reducing the use of unnecessary broad antibiotics. Moreover, cellular analysis and novel multi-omics techniques on BAL are of critical importance for understanding the microenvironment and interaction between epithelial cells and immunity, revealing novel potential prognostic and therapeutic targets. The BAL technique has been described as safe for both patients and healthcare workers in more than a thousand procedures reported to date in the literature. Based on these preliminary studies, we recognize that BAL is a feasible procedure in COVID-19 known or suspected cases, useful to properly guide patient management, and has great potential for research.
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Affiliation(s)
- Sara Tomassetti
- Interventional Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Luca Ciani
- Interventional Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Valentina Luzzi
- Interventional Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Leonardo Gori
- Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Marco Trigiani
- Interventional Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Leonardo Giuntoli
- Interventional Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Federico Lavorini
- Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Venerino Poletti
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Claudia Ravaglia
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Alfons Torrego
- Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Robert Lentz
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Simona Pollini
- Department of Experimental Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Ombretta Para
- Internal Medicine Unit 1, AOU Careggi, Florence, Italy
| | - Greta Ciurleo
- Internal Medicine Unit 2, AOU Careggi, Florence, Italy
| | | | - Laura Rasero
- Department of Health Science, Clinical Innovations and Research Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michele Spinicci
- Infectious and Tropical Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mohammed Munavvar
- School of Biological Sciences, The University of Manchester, Manchester, United Kingdom
- Department of Respiratory, Lancashire Teaching Hospital NHS Foundation Trust, Preston, United Kingdom
| | - Stefano Gasparini
- Interventional Pulmonology Unit, University Hospital Riuniti di Ancona, Ancona, Italy
| | - Camilla Comin
- Department of Experimental and Clinical Medicine Section of Surgery, Histopathology, and Molecular Pathology, University of Florence, Florence, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Peired
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Monique Henket
- Department of Respiratory Medicine, Universitary Hospital of Liège, Liège, Belgium
| | - Benoit Ernst
- Department of Respiratory Medicine, Universitary Hospital of Liège, Liège, Belgium
| | - Renaud Louis
- Department of Respiratory Medicine, Universitary Hospital of Liège, Liège, Belgium
| | - Jean-louis Corhay
- Department of Respiratory Medicine, Universitary Hospital of Liège, Liège, Belgium
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Florence, Italy
| | - Julien Guiot
- Department of Respiratory Medicine, Universitary Hospital of Liège, Liège, Belgium
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3
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Diagnostic Role of Bronchoalveolar Lavage in Patients with Suspected SARS-CoV-2 Pneumonia and Negative Upper Respiratory Tract Swab: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11164656. [PMID: 36012892 PMCID: PMC9409822 DOI: 10.3390/jcm11164656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/27/2022] [Accepted: 08/05/2022] [Indexed: 12/01/2022] Open
Abstract
The added role of bronchoalveolar lavage (BAL) in SARS-CoV-2 detection in hospitalized patients with suspected COVID-19 pneumonia and at least one negative nasopharyngeal swab (NPS) has yet to be definitively established. We aimed to provide a systematic review and meta-analysis to summarize data from the literature on the diagnostic yield of BAL in this context. We searched Medline and Embase for all studies reporting outcomes of interest published up to October 2021. Two authors reviewed all titles/abstracts and retrieved the selected full texts according to predefined selection criteria. The summary estimate was derived using the random-effects model. Thirteen original studies, involving 868 patients, were included. The summary estimate of proportions of SARS-CoV-2 positivity in BAL fluid in patients with at least one previous negative NPS was 20% (95% confidence interval [CI]; 11–30%). Moreover, microbiological tests of BAL fluid led to the identification of other pathogens, mainly bacteria, in up to two-thirds of cases. BAL plays a crucial role in the diagnostic work-up of patients with clinical suspicion of COVID-19 and previous negative NPS, as it allowed to detect the infection in a significant proportion of subjects, who would have been otherwise misclassified, with relevant implications in the prevention of disease spread, especially in hospital settings.
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De Clercq J, Malfait T, Malfait S, Boelens J, Coorevits L, Padalko E, Vandendriessche S, Verhasselt B, Morbée L, Bauters F, Hertegonne K, Stevens D, Vande Weygaerde Y, Vermaelen K, Van Biesen W, Vanommeslaeghe F, Verbeke F, Piers R, Van Den Noortgate N, Desmet T, Vermassen F, Vandekerckhove L, Van Braeckel E. Diagnosing COVID-19; towards a feasible COVID-19 rule-out protocol. Acta Clin Belg 2022; 77:368-376. [PMID: 33586631 PMCID: PMC7885724 DOI: 10.1080/17843286.2021.1883362] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: We present the results of the COVID-19 rule-out protocol at Ghent University Hospital, a step-wise testing approach which included repeat NFS SARS-CoV-2 rRT-PCR, respiratory multiplex RT-PCR, low-dose chest CT and bronchoscopy with BAL to confirm or rule-out SARS-CoV-2 infection in patients admitted with symptoms suggestive of COVID-19. Results: Between 19 March 2020 and 30 April 2020, 455 non-critically ill patients with symptoms suspect for COVID-19 were admitted. The initial NFS for SARS-CoV-2 rRT-PCR yielded 66.9%, the second NFS 25.4% and bronchoscopy with BAL 5.9% of total COVID-19 diagnoses. In the BAL fluid, other respiratory pathogens were detected in 65% (13/20) of the COVID-19 negative patients and only in 1/7 COVID-19 positive patients. Retrospective antibody testing at the time around BAL sampling showed a positive IgA or IgG in 42.9 % of the COVID-19 positive and 10.5% of the COVID-19 negative group. Follow-up serology showed 100% COVID-19 positivity in the COVID-19 positive group and 100% IgG negativity in the COVID-19 negative group. Conclusion: In our experience, bronchoscopy with BAL can have an added value to rule-in or rule-out COVID-19 in patients with clinical and radiographical high-likelihood of COVID-19 and repeated negative NFS testing. Furthermore, culture and respiratory multiplex PCR on BAL fluid can aid to identify alternative microbial etiological agents in this group. Retrospective analysis of antibody development in this selected group of patients suggests that the implementation of serological assays in the routine testing protocol will decrease the need for invasive procedures like bronchoscopy.
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Affiliation(s)
- J. De Clercq
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - T. Malfait
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - S. Malfait
- Strategic Policy Unit, Ghent University Hospital, Ghent, Belgium
| | - J. Boelens
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - L. Coorevits
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - E. Padalko
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - S. Vandendriessche
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - B. Verhasselt
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - L. Morbée
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - F. Bauters
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - K. Hertegonne
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - D. Stevens
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Y. Vande Weygaerde
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - K. Vermaelen
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - W. Van Biesen
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | | | - F. Verbeke
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - R. Piers
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - N. Van Den Noortgate
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - T. Desmet
- Emergency Department, Ghent University Hospital, Ghent, Belgium
| | - F. Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - L. Vandekerckhove
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - E. Van Braeckel
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
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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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Nasa P, Azoulay E, Chakrabarti A, Divatia JV, Jain R, Rodrigues C, Rosenthal VD, Alhazzani W, Arabi YM, Bakker J, Bassetti M, De Waele J, Dimopoulos G, Du B, Einav S, Evans L, Finfer S, Guérin C, Hammond NE, Jaber S, Kleinpell RM, Koh Y, Kollef M, Levy MM, Machado FR, Mancebo J, Martin-Loeches I, Mer M, Niederman MS, Pelosi P, Perner A, Peter JV, Phua J, Piquilloud L, Pletz MW, Rhodes A, Schultz MJ, Singer M, Timsit JF, Venkatesh B, Vincent JL, Welte T, Myatra SN. Infection control in the intensive care unit: expert consensus statements for SARS-CoV-2 using a Delphi method. THE LANCET. INFECTIOUS DISEASES 2022; 22:e74-e87. [PMID: 34774188 PMCID: PMC8580499 DOI: 10.1016/s1473-3099(21)00626-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 02/07/2023]
Abstract
During the current COVID-19 pandemic, health-care workers and uninfected patients in intensive care units (ICUs) are at risk of being infected with SARS-CoV-2 as a result of transmission from infected patients and health-care workers. In the absence of high-quality evidence on the transmission of SARS-CoV-2, clinical practice of infection control and prevention in ICUs varies widely. Using a Delphi process, international experts in intensive care, infectious diseases, and infection control developed consensus statements on infection control for SARS-CoV-2 in an ICU. Consensus was achieved for 31 (94%) of 33 statements, from which 25 clinical practice statements were issued. These statements include guidance on ICU design and engineering, health-care worker safety, visiting policy, personal protective equipment, patients and procedures, disinfection, and sterilisation. Consensus was not reached on optimal return to work criteria for health-care workers who were infected with SARS-CoV-2 or the acceptable disinfection strategy for heat-sensitive instruments used for airway management of patients with SARS-CoV-2 infection. Well designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.
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Affiliation(s)
- Prashant Nasa
- NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Elie Azoulay
- Saint-Louis Teaching Hospital, APHP, University of Paris, Paris, France
| | | | | | - Ravi Jain
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Camilla Rodrigues
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Yaseen M Arabi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jan Bakker
- New York University Grossman School of Medicine, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Erasmus University Medical Center, Rotterdam, Netherlands; Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - George Dimopoulos
- Attikon University Hospital, Athens, Greece; National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Bin Du
- State Key Laboratory of Rare, Complex and Critical Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Sharon Einav
- Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | | | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Imperial College London, London, UK
| | - Claude Guérin
- University de Lyon, Lyon, France; Institut Mondor de Recherches Biomédicales, Créteil, France
| | - Naomi E Hammond
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Newton, Adelaide, SA, Australia
| | - Samir Jaber
- Hôpital Saint-Éloi, Montpellier University Hospital, Montpellier, France
| | - Ruth M Kleinpell
- Vanderbilt University School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Younsuck Koh
- College of Medicine, University of Ulsan College of Medicine, University of Ulsan, Seoul, South Korea
| | - Marin Kollef
- Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Mitchell M Levy
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Flavia R Machado
- Hospital Sao Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | | | - Paolo Pelosi
- IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy; University of Genoa, Genoa, Italy
| | - Anders Perner
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jason Phua
- Alexandra Hospital, National University Health System, Singapore; National University Hospital, National University Health System, Singapore
| | - Lise Piquilloud
- University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Andrew Rhodes
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marcus J Schultz
- Amsterdam University Medical Centers, Locatie AMC, Amsterdam, Netherlands; Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | | | - Tobias Welte
- German Center of Lung Research, Hannover, Germany
| | - Sheila N Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
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7
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Page JH, Londhe AA, Brooks C, Zhang J, Sprafka JM, Bennett C, Braunlin M, Brown CA, Charuworn P, Cheng A, Gill K, He F, Ma J, Petersen J, Ayodele O, Bao Y, Carlson KB, Chang SC, Devercelli G, Jonsson-Funk M, Jiang J, Keenan HA, Ren K, Roehl KA, Sanders L, Wang L, Wei Z, Xia Q, Yu P, Zhou L, Zhu J, Gondek K, Critchlow CW, Bradbury BD. Trends in characteristics and outcomes among US adults hospitalised with COVID-19 throughout 2020: an observational cohort study. BMJ Open 2022; 12:e055137. [PMID: 35228287 PMCID: PMC8886119 DOI: 10.1136/bmjopen-2021-055137] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To examine the temporal patterns of patient characteristics, treatments used and outcomes associated with COVID-19 in patients who were hospitalised for the disease between January and 15 November 2020. DESIGN Observational cohort study. SETTING COVID-19 subset of the Optum deidentified electronic health records, including more than 1.8 million patients from across the USA. PARTICIPANTS There were 51 510 hospitalised patients who met the COVID-19 definition, with 37 617 in the laboratory positive cohort and 13 893 in the clinical cohort. PRIMARY AND SECONDARY OUTCOME MEASURES Incident acute clinical outcomes, including in-hospital all-cause mortality. RESULTS Respectively, 48% and 49% of the laboratory positive and clinical cohorts were women. The 50- 65 age group was the median age group for both cohorts. The use of antivirals and dexamethasone increased over time, fivefold and twofold, respectively, while the use of hydroxychloroquine declined by 98%. Among adult patients in the laboratory positive cohort, absolute age/sex standardised incidence proportion for in-hospital death changed by -0.036 per month (95% CI -0.042 to -0.031) from March to June 2020, but remained fairly flat from June to November, 2020 (0.001 (95% CI -0.001 to 0.003), 17.5% (660 deaths /3986 persons) in March and 10.2% (580/5137) in October); in the clinical cohort, the corresponding changes were -0.024 (95% CI -0.032 to -0.015) and 0.011 (95% CI 0.007 0.014), respectively (14.8% (175/1252) in March, 15.3% (189/1203) in October). Declines in the cumulative incidence of most acute clinical outcomes were observed in the laboratory positive cohort, but not for the clinical cohort. CONCLUSION The incidence of adverse clinical outcomes remains high among COVID-19 patients with clinical diagnosis only. Patients with COVID-19 entering the hospital are at elevated risk of adverse outcomes.
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Affiliation(s)
- John H Page
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Ajit A Londhe
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Corinne Brooks
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Jie Zhang
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - J Michael Sprafka
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
- Woodford Research Associates, Thousand Oaks, California, USA
| | - Corina Bennett
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Megan Braunlin
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Carolyn A Brown
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Prista Charuworn
- Inflammation, Global Development, Amgen Inc, Thousand Oaks, California, USA
| | - Alvan Cheng
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Karminder Gill
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Fang He
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Junjie Ma
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | | | - Olulade Ayodele
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Ying Bao
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Katherine B Carlson
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Shun-Chiao Chang
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Giovanna Devercelli
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
- Global Evidence and Outcomes, Takeda Pharmaceutical Company Limited, Pinehurst, North Carolina, USA
| | - Michele Jonsson-Funk
- Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Jenny Jiang
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Hillary A Keenan
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Kaili Ren
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Kimberly A Roehl
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Lynn Sanders
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Luyang Wang
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Zhongyuan Wei
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Qian Xia
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Peter Yu
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Linyun Zhou
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Julia Zhu
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Kathleen Gondek
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | | | - Brian D Bradbury
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
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8
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Vandervore L, Van Mieghem E, Nowé V, Schouwers S, Steger C, Abrams P, Schaeren JV, Meskal A, Vandamme T. False positive Herpes Simplex IgM serology in COVID-19 patients correlates with SARS-CoV-2 IgM/IgG seropositivity. Diagn Microbiol Infect Dis 2022; 103:115653. [PMID: 35228129 PMCID: PMC8802144 DOI: 10.1016/j.diagmicrobio.2022.115653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/23/2021] [Accepted: 01/21/2022] [Indexed: 12/31/2022]
Abstract
Differentiating COVID-19 from other causes of viral pneumonia, like herpes simplex (HSV), can be complicated by shared clinical and laboratory features. Viral pneumonia is mostly diagnosed based on molecular or serological techniques. Serological immunoassay interferences, often attributed to concurrent appearance of heterologous (viral) immunoglobulins, is well-known, but has not been studied in COVID-19 patients. Following false positive HSV immunoglobulin M (IgM) results in our index patient, 25 other COVID-19 patients were tested for HSV-1/2 IgM with the chemiluminescent Liaison assay and Euroimmun enzyme-linked immunosorbent assay. Forty-five percent of COVID-19 patients tested positive for HSV IgM with Liaison. No HSV indices were positive with Euroimmun enzyme-linked immunosorbent assay, suggesting immunoassay interference. Significant correlation between HSV IgM and SARS-CoV-2 IgM/IgG positivity was found. Adding 0.5% polyvinylpyrrolidone, inhibiting non-specific solid-phase adsorption, abolished interference in 22% of false positive cases, suggesting interference caused by solid-phase reactive IgM. Hence, serologic immunoassay results should be interpreted with caution in COVID-19 patients.
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9
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A systematic review and metanalysis of diagnostic yield of BAL for detection of SARS-CoV-2. Heart Lung 2021; 52:95-105. [PMID: 34929538 PMCID: PMC8666306 DOI: 10.1016/j.hrtlng.2021.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The gold standard for diagnosing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is microbiological confirmation by reverse transcriptase-polymerase chain reaction (RT-PCR)1 most commonly done using oropharyngeal (OP) and nasopharyngeal swabs (NP). But in suspected cases, where these samples are false-negative, bronchoalveolar lavage (BAL) may prove diagnostic. OBJECTIVES Hence, the diagnostic yield of BAL for detection of SARS-CoV-2 in cases of non-diagnostic upper respiratory tract samples is reviewed. METHODS Databases such as MEDLINE, Scopus, and Google Scholar were searched using a systematic search strategy. The current study has been in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and has been registered with the International Prospective Registry of Systematic Reviews (CRD42020224088). RESULTS 911 records were identified at initial database extraction, of which 317 duplicates were removed and, 596 records were screened for inclusion eligibility. We included total 19 studies in the systematic review, and 17 were included in metanalysis. The pooled estimate of SARS-CoV-2 positivity in BAL was 11% (95%CI: 0.01-0.24). A sensitivity analysis also showed that the results appear to be robust and minimal risk of bias amongst the studies. CONCLUSION The current study demonstrates that BAL can be used to diagnose additional cases primary disease and superadded infections in patients with severe COVID-19 lower respiratory tract infection.
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10
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The Role of Bronchoscopy in the Diagnosis and Management of Patients with SARS-Cov-2 Infection. Diagnostics (Basel) 2021; 11:diagnostics11101938. [PMID: 34679633 PMCID: PMC8534996 DOI: 10.3390/diagnostics11101938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/25/2023] Open
Abstract
Bronchoscopy has several major diagnostic and therapeutic indications in pulmonology. However, it is an aerosol-generating procedure that places healthcare providers at an increased risk of infection. Now more than ever, during the spread of the coronavirus disease 2019 (COVID-19) pandemic, the infectious risk during bronchoscopy is significantly raised, and for this reason its role in diagnostic management is debated. In this review, we summarized current evidence regarding the indications for bronchoscopy and the measures that should be applied to decrease risk exposure. Indeed, seeing the long-lasting period of the pandemic, resuming standard of care for all patients is required.
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11
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Barberi C, Castelnuovo E, Dipasquale A, Mrakic Sposta F, Vatteroni G, Canziani LM, Alloisio M, Ciccarelli M, Selmi C, Ferraroli GM. Bronchoalveolar lavage in suspected COVID-19 cases with a negative nasopharyngeal swab: a retrospective cross-sectional study in a high-impact Northern Italy area. Intern Emerg Med 2021; 16:1857-1864. [PMID: 33770367 PMCID: PMC7994348 DOI: 10.1007/s11739-021-02714-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/14/2021] [Indexed: 12/20/2022]
Abstract
COVID-19 diagnosis relies on molecular testing for SARS-CoV-2 via nasopharyngeal swab in the presence of suggestive clinical, radiological and laboratory findings. Since bronchoalveolar lavage liquid (BAL) collected during fibrobronchoscopy may increase test sensitivity compared to nasopharyngeal swabs, it was performed during the 2020 pandemic in clinically or radiologically suspected cases. Our aim was to determine whether clinical features, chest computed tomography (CT) findings or laboratory tests may predict patients testing positive for SARS-CoV-2 at BAL after a negative nasopharyngeal swab. We performed a retrospective cross-sectional study with multivariable analysis of suspected patients who were tested for SARS-CoV-2 at BAL after at least one negative nasopharyngeal swab. Univariable logistic regression for odds ratio and multivariate models was calculated to determine clinical, radiological and laboratory predictors. 32/198 (16%) patients had BAL positive for SARS-CoV-2, while 65/198 tested positive for other pathogens at BAL. Of the 32 patients positive for COVID, 4 had a coinfection at BAL, being thus positive both for COVID as well as for another pathogen while the remaining 105 patients were negative for COVID and other pathogens at BAL. COVID-19 patients had more often highly suggestive CT findings, higher number of involved lobes, more often ground glass opacity of more than 50% of lung parenchyma, and less frequently other radiologically suspected infections. At multivariate model, temperature also predicted BAL positivity. The procedure was well tolerated-with only one desaturation episode-while no healthcare worker was infected. In conclusion, when nasopharyngeal swabs are negative but there is clinical or imaging suspicion of COVID-19, BAL represents a complementary diagnostic tool, particularly in conjunction with suggestive/more extensive lung involvement at CT scan. The procedure did not carry increased risks for patients nor for operators, while allowing to free hospital resources, avoiding unnecessary isolations.
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Affiliation(s)
- Caterina Barberi
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan Italy
- Department of Emergency Medicine, Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan Italy
| | - Elena Castelnuovo
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan Italy
- Department of Emergency Medicine, Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan Italy
| | - Andrea Dipasquale
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan Italy
- Department of Internal Medicine, Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan Italy
| | - Federica Mrakic Sposta
- Department of Radiology, Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan Italy
| | - Giulia Vatteroni
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan Italy
- Department of Radiology, Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan Italy
| | - Lorenzo Maria Canziani
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan Italy
- Department of Internal Medicine, Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan Italy
| | - Marco Alloisio
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan Italy
- Department of Thoracic Surgery, Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan Italy
| | - Michele Ciccarelli
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan Italy
- Department of Pulmonology, Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan Italy
| | - Carlo Selmi
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan Italy
- Department of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan Italy
| | - Giorgio Maria Ferraroli
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan Italy
- Department of Thoracic Surgery, Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan Italy
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12
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Patrucco F, Airoldi C, Falaschi Z, Bellan M, Castello LM, Filippone F, Matranga S, Masellis S, Smeriglia A, Solidoro P, Balbo PE, Gavelli F. Mycotic infection prevalence among patients undergoing bronchoalveolar lavage with search of SARS-CoV-2 after two negative nasopharyngeal swabs. J Breath Res 2021; 15. [PMID: 34464944 DOI: 10.1088/1752-7163/ac2290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/31/2021] [Indexed: 11/11/2022]
Abstract
The evidence that severe coronavirus disease 2019 (COVID-19) is a risk factor for development of mycotic respiratory infection with an increased mortality is rising. Immunosuppressed are among the most susceptible patients andAspergillusspecies is the most feared superinfection. In this study we evaluated mycotic isolation prevalence on bronchoalveolar lavage (BAL) of patients who underwent bronchoscopy in search of severe acute respiratory coronavirus 2 (SARS-CoV-2) RNA. Moreover, we described the clinical characteristics and main outcomes of these patients. We included 118 patients, 35.9% of them were immunosuppressed for different reasons: in 23.7% we isolated SARS-CoV-2 RNA, in 33.1% we identified at least one mycotic agent and both in 15.4%. On BAL we observed in three casesAspergillusspp, in six casesPneumocystisand in 32Candidaspp. The prevalence of significant mold infection was 29.3% and 70.7% of cases were false positive or clinically irrelevant infections. In-hospital mortality of patients with fungal infection was 15.3%. The most frequent computed tomography (CT) pattern, evaluated with the Radiological Society of North America consensus statement, among patients with a mycotic pulmonary infection was the atypical one (p< 0.0001). Mycotic isolation on BAL may be interpreted as an innocent bystander, but its identification could influence the prognosis of patients, especially in those who need invasive investigations during the COVID-19 pandemic; BAL plays a fundamental role in resolving clinical complex cases, especially in immunosuppressed patients independently from radiological features, without limiting its role in ruling out SARS-CoV-2 infection.
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Affiliation(s)
- Filippo Patrucco
- Medical Department, Division of Respiratory Diseases, Maggiore della Carità Hospital, Novara, Italy.,Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Zeno Falaschi
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Maggiore della Carità Hospital, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Medical Department, Internal Medicine Unit, Maggiore della Carità Hospital, Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Emergency Medicine Department, Maggiore della Carità Hospital, Novara, Italy
| | - Francesco Filippone
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Maggiore della Carità Hospital, Novara, Italy
| | - Simone Matranga
- Emergency Medicine Department, Maggiore della Carità Hospital, Novara, Italy
| | - Serena Masellis
- Emergency Medicine Department, Maggiore della Carità Hospital, Novara, Italy
| | - Aurora Smeriglia
- Emergency Medicine Department, Maggiore della Carità Hospital, Novara, Italy
| | - Paolo Solidoro
- Cardiovascular and Thoracic Department, Pneumology Unit U, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Piero Emilio Balbo
- Medical Department, Division of Respiratory Diseases, Maggiore della Carità Hospital, Novara, Italy
| | - Francesco Gavelli
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Emergency Medicine Department, Maggiore della Carità Hospital, Novara, Italy
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13
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Mahmood K, Abbott M, Van Nostrand K, Bechara R, Gonzalez AV, Brucker A, Green CL, Polage CR. Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience. BMJ Open Respir Res 2021; 8:8/1/e000962. [PMID: 34301713 PMCID: PMC8313310 DOI: 10.1136/bmjresp-2021-000962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/05/2021] [Indexed: 12/25/2022] Open
Abstract
Objective For the diagnosis of COVID-19, the yield of nasopharyngeal (NP) swabs is unclear, and bronchoalveolar lavage (BAL) is obtained to confirm the diagnosis. We assessed the utilisation of bronchoscopy for COVID-19 diagnosis in a multicenter study and compared the diagnostic yield of BAL versus NP swabs. Methods This retrospective study included all patients who were admitted with clinical presentation concerning for COVID-19 and underwent BAL from 1 March to 31 July 2020 at four tertiary care centres in North America. We also compared concordance of BAL with NP swabs for diagnosis of COVID-19 infection. Results Fifty-three patients, with clinical suspicion for COVID-19 and admitted for respiratory failure, underwent bronchoscopy to collect BAL for SARS-CoV-2 testing. During the same period, 2039 bronchoscopies were performed on patients not infected with COVID-19. Of 42 patients with NP swabs and BAL collected within ≤7 days, 1 was NP swab negative but positive by BAL for SARS-CoV-2 (n=1/42 (2.4%)). Across a wide array of testing platforms, the overall agreement between NP swabs and BAL results was 97.6% (95% CI: 93.0% to 100%) with Cohen’s k of 0.90 (95% CI: 0.69 to 1.00). The sensitivity, specificity, positive and negative predictive values of NP swabs compared with BAL were 83.3% (95% CI: 53.5% to 100%), 100%, 100% and 97.3% (95% CI: 92.1% to 100%), respectively. Conclusions BAL was used infrequently to assess COVID-19 in busy institutions. NP swabs have a high concordance with BAL for COVID-19 testing, but negative NP swabs should be confirmed with BAL when clinical suspicion is high.
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Affiliation(s)
- Kamran Mahmood
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, North Carolina, USA
| | - Matt Abbott
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, North Carolina, USA
| | - Keriann Van Nostrand
- Department of Medicine, Division of Pulmonary and Critical Care, Emory University, Atlanta, Georgia, USA
| | - Rabih Bechara
- Department of Medicine, Division of Pulmonary and Critical Care, Medical College of Georgia, Augusta, Georgia, USA
| | - Anne V Gonzalez
- Department of Medicine, Division of Pulmonary and Critical Care, McGill University, Montreal, Quebec, Canada
| | - Amanda Brucker
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
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14
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Arenas-De Larriva M, Martín-DeLeon R, Urrutia Royo B, Fernández-Navamuel I, Gimenez Velando A, Nuñez García L, Centeno Clemente C, Andreo García F, Rafecas Codern A, Fernández-Arias C, Pajares Ruiz V, Torrego Fernández A, Rajas O, Iturricastillo G, Garcia Lujan R, Comeche Casanova L, Sánchez-Font A, Aguilar-Colindres R, Larrosa-Barrero R, García García R, Cordovilla R, Núñez-Ares A, Briones-Gómez A, Cases Viedma E, Franco J, Cosano Povedano J, Rodríguez-Perálvarez ML, Cebrian Gallardo JJ, Nuñez Delgado M, Pavón-Masa M, Valdivia Salas MDM, Flandes J. The role of bronchoscopy in patients with SARS-CoV-2 pneumonia. ERJ Open Res 2021; 7:00165-2021. [PMID: 34258257 PMCID: PMC8183029 DOI: 10.1183/23120541.00165-2021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/22/2021] [Indexed: 12/18/2022] Open
Abstract
Background The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate. Patients and methods This observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression. Results A total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR 1.60; p=0.041), absence of mucosal hyperaemia (OR 0.49; p=0.041) and the presence of haematic secretions (OR 1.79; p=0.032). Conclusion Bronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19. Bronchoscopy is part of the armamentarium against #COVID19. It allows diagnosis, facilitates mechanical ventilation and provides prognostic information. This information could be used to refine healthcare pathways in order to improve outcomes.https://bit.ly/2QuAQOt
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Affiliation(s)
- Marisol Arenas-De Larriva
- Dept of Bronchoscopy and Interventional Pulmonology, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
| | | | - Blanca Urrutia Royo
- Pulmonary Dept, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Iker Fernández-Navamuel
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundacion Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain
| | - Andrés Gimenez Velando
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundacion Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain
| | - Laura Nuñez García
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundacion Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain
| | - Carmen Centeno Clemente
- Interventional Pulmonology Unit, Pulmonary Dept, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, UAB, IGTP, Badalona, Spain
| | - Felipe Andreo García
- Interventional Pulmonology Unit, Pulmonary Dept, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, UAB, IGTP, Badalona, Spain
| | | | | | | | | | - Olga Rajas
- Interventional Pulmonology Unit, Pulmonology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Madrid, Spain
| | - Gorane Iturricastillo
- Pulmonology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Madrid, Spain
| | - Ricardo Garcia Lujan
- Dept of Interventional Pulmonology, Hospital Universitario 12 Octubre and Hospital Univesitario Quirónsalud Madrid, Madrid, Spain
| | | | - Albert Sánchez-Font
- Pulmonology Dept, Hospital del Mar, CIBERES, UAB, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | | | - Ruth García García
- Interventional Pulmonology Unit, Pulmonary Dept, Salamanca University Hospital, Salamanca, Spain
| | - Rosa Cordovilla
- Interventional Pulmonology Unit, Pulmonary Dept, Salamanca University Hospital, Salamanca, Spain
| | - Ana Núñez-Ares
- Interventional Pulmonology Unit, Pulmonary Dept, Albacete, Spain
| | - Andrés Briones-Gómez
- Interventional Pulmonology Unit, Pulmonary Dept, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Enrique Cases Viedma
- Interventional Pulmonology Unit, Pulmonary Dept, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Franco
- Pneumology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Javier Cosano Povedano
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
| | | | | | - Manuel Nuñez Delgado
- Dept of Bronchoscopy and Interventional Pulmonology, Hospital Álvaro Cunqueiro, CHUVI, Vigo, Spain
| | - María Pavón-Masa
- Dept of Interventional Pulmonology, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Javier Flandes
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundación Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain
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15
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Pandey V, Misra N, Greeshma R, Astha A, Jeyavel S, Lakshmana G, Rajkumar E, Prabhu G. Techno Trend Awareness and Its Attitude Towards Social Connectedness and Mitigating Factors of COVID-19. Front Psychol 2021; 12:637395. [PMID: 34113286 PMCID: PMC8185047 DOI: 10.3389/fpsyg.2021.637395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
While COVID-19 has taken a toll on many professions and livelihood of all walks of lives, technology has amplified its intrusion to ease the necessities. Innovative technology, therefore, has improved the glitches and provided the software to adhere to these new normal. However, individuals' awareness and attitude toward the advancements of these technological trends need to be addressed. Although the government has taken measures to prevent and curb the growing cases for COVID-19 with the help of technology, the support from the individuals would depend mostly on their level of awareness and the attitude toward those measures. The present qualitative study explored the techno trend awareness, perception and attitudes of techno experts and technical professionals toward social connectedness and mitigating factors of COVID-19. Besides, it also explained individuals' shift toward virtual interaction to maintain social connections during the pandemic. The thematic analysis generated four prominent themes. Social Connectedness, emphasized on the emotional connections that created a positive feeling of belongingness. Technological Advancement provided three sub-themes highlighting perception, techno trend awareness and desirable attitudes toward the mitigation of COVID-19. The categories under Treatment and Preventive Measures indicated the enhanced self-care of individuals and also the tendencies to minimize the spread of diseases. The emergence of the theme Inclination toward Indigenous Knowledge, which is an important finding, indicated the techno-experts inclination toward the indigenous knowledge amid vague scientific shreds of evidence.
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Affiliation(s)
- Vijyendra Pandey
- Department of Psychology, Central University of Karnataka, Gulbarga, India
| | - Neelam Misra
- Department of Microbiology, Gulbarga University, Gulbarga, India
| | - Rajgopal Greeshma
- Department of Psychology, Central University of Karnataka, Gulbarga, India
| | - Arora Astha
- Department of Psychology, Central University of Karnataka, Gulbarga, India
| | | | | | - Eslavath Rajkumar
- Department of Psychology, Central University of Karnataka, Gulbarga, India
| | - G Prabhu
- Department of Psychology, Central University of Karnataka, Gulbarga, India
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16
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Falzone L, Gattuso G, Tsatsakis A, Spandidos DA, Libra M. Current and innovative methods for the diagnosis of COVID‑19 infection (Review). Int J Mol Med 2021; 47:100. [PMID: 33846767 PMCID: PMC8043662 DOI: 10.3892/ijmm.2021.4933] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID‑19) pandemic has forced the scientific community to rapidly develop highly reliable diagnostic methods in order to effectively and accurately diagnose this pathology, thus limiting the spread of infection. Although the structural and molecular characteristics of the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) were initially unknown, various diagnostic strategies useful for making a correct diagnosis of COVID‑19 have been rapidly developed by private research laboratories and biomedical companies. At present, rapid antigen or antibody tests, immunoenzymatic serological tests and molecular tests based on RT‑PCR are the most widely used and validated techniques worldwide. Apart from these conventional methods, other techniques, including isothermal nucleic acid amplification techniques, clusters of regularly interspaced short palindromic repeats/Cas (CRISPR/Cas)‑based approaches or digital PCR methods are currently used in research contexts or are awaiting approval for diagnostic use by competent authorities. In order to provide guidance for the correct use of COVID‑19 diagnostic tests, the present review describes the diagnostic strategies available which may be used for the diagnosis of COVID‑19 infection in both clinical and research settings. In particular, the technical and instrumental characteristics of the diagnostic methods used are described herein. In addition, updated and detailed information about the type of sample, the modality and the timing of use of specific tests are also discussed.
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Affiliation(s)
- Luca Falzone
- Epidemiology and Biostatistics Unit, National Cancer Institute-IRCCS 'Fondazione G. Pascale', I-80131 Naples, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95123 Catania, Italy
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, 71003 Heraklion, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95123 Catania, Italy
- Research Center for the Prevention, Diagnosis and Treatment of Tumors, University of Catania, I-95123 Catania, Italy
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17
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Falzone L, Gattuso G, Tsatsakis A, Spandidos DA, Libra M. Current and innovative methods for the diagnosis of COVID‑19 infection (Review). Int J Mol Med 2021. [PMID: 33846767 DOI: 10.3892/ijmm.2021.4933/html] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID‑19) pandemic has forced the scientific community to rapidly develop highly reliable diagnostic methods in order to effectively and accurately diagnose this pathology, thus limiting the spread of infection. Although the structural and molecular characteristics of the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) were initially unknown, various diagnostic strategies useful for making a correct diagnosis of COVID‑19 have been rapidly developed by private research laboratories and biomedical companies. At present, rapid antigen or antibody tests, immunoenzymatic serological tests and molecular tests based on RT‑PCR are the most widely used and validated techniques worldwide. Apart from these conventional methods, other techniques, including isothermal nucleic acid amplification techniques, clusters of regularly interspaced short palindromic repeats/Cas (CRISPR/Cas)‑based approaches or digital PCR methods are currently used in research contexts or are awaiting approval for diagnostic use by competent authorities. In order to provide guidance for the correct use of COVID‑19 diagnostic tests, the present review describes the diagnostic strategies available which may be used for the diagnosis of COVID‑19 infection in both clinical and research settings. In particular, the technical and instrumental characteristics of the diagnostic methods used are described herein. In addition, updated and detailed information about the type of sample, the modality and the timing of use of specific tests are also discussed.
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Affiliation(s)
- Luca Falzone
- Epidemiology and Biostatistics Unit, National Cancer Institute‑IRCCS 'Fondazione G. Pascale', I‑80131 Naples, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
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18
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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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19
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Oberg CL, Ronaghi R, Folch EE, Channick CL, He T, Susanto I, Oh SS. Pre-Procedural COVID-19 Nasopharyngeal Swab Has Good Concordance with Bronchoalveolar Lavage in Patients at Low Risk for Viral Infection. Respiration 2021; 100:510-514. [PMID: 33540412 PMCID: PMC8089431 DOI: 10.1159/000514928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has drastically affected hospital and operating room (OR) workflow around the world as well as trainee education. Many institutions have instituted mandatory preoperative SARS-CoV-2 PCR nasopharyngeal swab (NS) testing in patients who are low risk for COVID-19 prior to elective cases. This method, however, is challenging as the sensitivity, specificity, and overall reliability of testing remains unclear. Objectives The objective of this study was to assess the concordance of a negative NS in low risk preoperative patients with lower airway bronchoalveolar lavage (BAL) specimens obtained from the same patients. Methods We prospectively sent intraoperative lower airway BAL samples collected within 48 h of a negative mandatory preoperative NS for SARS-CoV-2 PCR testing. All adult patients undergoing a scheduled bronchoscopic procedure for any reason were enrolled, including elective and nonelective cases. Results One-hundred eighty-nine patients were included. All BAL specimens were negative for SARS-CoV-2 indicative of 100% concordance between testing modalities. Conclusions These results are promising and suggest that preoperative nasopharyngeal SARS-CoV-2 testing provides adequate screening to rule out active COVID-19 infection prior to OR cases in a population characterized as low risk by negative symptom screening. This information can be used for both pre-procedural screening and when reintroducing trainees into the workforce.
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Affiliation(s)
- Catherine L Oberg
- Section of Interventional Pulmonology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Reza Ronaghi
- Section of Interventional Pulmonology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Erik E Folch
- Section of Interventional Pulmonology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Colleen L Channick
- Section of Interventional Pulmonology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Tao He
- Section of Interventional Pulmonology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Irawan Susanto
- Section of Interventional Pulmonology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Scott S Oh
- Section of Interventional Pulmonology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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20
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Folch EE, Oberg CL, Mehta AC, Majid A, Keyes C, Fernandez-Bussy S. Argon Plasma Coagulation: Elucidation of the Mechanism of Gas Embolism. Respiration 2021:1-5. [PMID: 33540412 PMCID: PMC8089431 DOI: 10.1159/000512687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Argon plasma coagulation (APC) is a tool used in the management of tracheobronchial obstruction or bleeding. Complications include gas embolism which can cause devastating effects including hemodynamic instability, cardiac arrest, and stroke. Multiple theories as to how gas embolism occurs with APC have been postulated; however, none have identified the exact mechanism. OBJECTIVES To identify the mechanism by which APC causes gas embolism in the tracheobronchial tree. METHODS Using an explanted porcine tracheobronchial tree with lung parenchyma, the APC catheter was applied through noncontact and direct contact to the endobronchial airway mucosa via flexible bronchoscopy. This was done at multiple gas flow settings and pulse durations. Visual changes in the mucosa were photographed, videoed, and described. RESULTS Gross evidence of submucosal gas transfer occurred when the APC catheter was in direct contact with the mucosa at all gas flow settings in all applications, despite using shorter pulse durations. Whenever the catheter was not in contact with the mucosa, there was no transfer of gas at any gas flow setting or pulse duration. CONCLUSIONS Direct mucosal contact with the APC probe leads to submucosal gas deposition and is a likely mechanism for gas entry into the intravascular space. In reported cases of APC-associated gas embolism, presence of a vascularized endobronchial tumor may have increased the risk of gas tracking into the intravascular space. Care should be taken when applying APC during brisk bleeding or limited vision, as inadvertent mucosal contact may occur and could increase the risk of gas embolism.
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Affiliation(s)
- Erik E Folch
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,
| | - Catherine L Oberg
- Division of Pulmonary, Critical Care, Allergy and Immunology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Atul C Mehta
- Division of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Colleen Keyes
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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21
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Patrucco F, Albera C, Bellocchia M, Foci V, Gavelli F, Castello LM, Bellan M, Sainaghi PP, Airoldi C, Balbo PE, Solidoro P. SARS-CoV-2 Detection on Bronchoalveolar Lavage: An Italian Multicenter experience. Respiration 2020; 99:970-978. [PMID: 33075793 PMCID: PMC7649696 DOI: 10.1159/000511964] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/25/2020] [Indexed: 11/19/2022] Open
Abstract
Background Bronchoscopy with bronchoalveolar lavage (BAL) during the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) pandemic should be reserved to a limited number of clinical indications. The yield of BAL for the diagnosis of suspected or confirmed pulmonary SARS-CoV-2 infection is still unknown. Objectives We aimed to evaluate the diagnostic ratio of BAL in detecting SARS-CoV-2 pulmonary infection in patients undergoing bronchoscopy for different indications as well as describe the clinical, radiological, and endoscopic characteristics of patients with SARS-CoV-2 on BAL. Method We conducted a multicenter retrospective study including all patients who underwent bronchoscopy for the detection of SARS-CoV-2 on BAL. Clinical, computed tomography (CT), endoscopic, and microbiologic data were gathered from March 16th to May 27th, 2020. Results 131 patients were included. Bronchoscopy was performed for suspected SARS-CoV-2 infection (65.5%), alternative diagnosis (12.9%), suspected superinfections (19.8%), and lung atelectasis (1.5%). SARS-CoV-2 was isolated on BAL 43 times (32.8%) and the highest isolation rate was in patients with suspected SARS-CoV-2 infection (74.4%); 76% of positive patients had a double-negative nasopharyngeal swab. Peripheral, posterior and multilobar CT opacities were more frequent in SARS-CoV-2 patients, and the number of CT findings was higher in positive patients, particularly those with suspected SARS-CoV-2 infection. We recorded a progressive reduction of SARS-CoV-2 isolation during the observation period. Conclusions In our centers, the rate of detection of SARS-CoV-2 on BAL in patients with suspected infection was 37.2%. The agreement of BAL with nasopharyngeal swabs was high; CT alterations could predict the pretest probability of SARS-CoV-2 infection, but suspicion of viral infection should be always considered.
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Affiliation(s)
- Filippo Patrucco
- Medical Department, Division of Respiratory Diseases, "AOU Maggiore della Carità", Novara, Italy, .,Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy,
| | - Carlo Albera
- Cardiovascular and Thoracic Department, Respiratory Diseases Unit U, "AOU Città della Salute e della Scienza", Torino, Italy.,Medical Science Department, University of Turin, Torino, Italy
| | - Michela Bellocchia
- Cardiovascular and Thoracic Department, Respiratory Diseases Unit U, "AOU Città della Salute e della Scienza", Torino, Italy
| | - Valentina Foci
- Hospital and Specialistic Department, Respiratory Diseases Unit U, ASL Vercelli, Vercelli, Italy
| | - Francesco Gavelli
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Emergency Medicine Department, "AOU Maggiore della Carità", Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Emergency Medicine Department, "AOU Maggiore della Carità", Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Medical Department, Internal Medicine Division, "AOU Maggiore della Carità", Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Medical Department, Internal Medicine Division, "AOU Maggiore della Carità", Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Piero Emilio Balbo
- Medical Department, Division of Respiratory Diseases, "AOU Maggiore della Carità", Novara, Italy
| | - Paolo Solidoro
- Cardiovascular and Thoracic Department, Respiratory Diseases Unit U, "AOU Città della Salute e della Scienza", Torino, Italy.,Medical Science Department, University of Turin, Torino, Italy
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