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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: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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