Bronchoscopic Intervention May be Associated with Better Outcomes in Mechanically Ventilated Coronavirus Disease-19 Patients: A Case Series
Keywords:Coronavirus disease-19, Acute respiratory distress syndrome, Bronchoscopy intervention
BACKGROUND: The emergence of a new strain of coronavirus infection, the coronavirus infection disease 2019 (COVID-19), has been a pandemic burden across the globe. Severe COVID-19, particularly in patients with acute respiratory distress syndrome (ARDS), is associated with increased risk of admission to intensive care unit (ICU), mechanical ventilation, and mortality. Bronchoscopy has been widely employed as an adjunctive therapy in mechanically ventilated patients. However, the use of bronchoscopy in patients with COVID-19 has been strictly limited due to aerosol transmission.
CASE REPORT: We reported 3 COVID-19 Cases presented to the hospital with ARDS. All of the patients were immediately intubated to improve oxygenation. During admission, the patients produced immense airway secretions that might have resulted in partial airway obstruction. A conventional tracheal suctioning did not help to promote clinical improvement. We decided to perform bronchoscopy with controlled suctioning by following a very tight protocol to prevent aerosol formation. A significant clinical and respiratory improvement was observed in all patients following bronchoscopy. Three of them were transferred to regular ward, however, one patient died during hospitalization.
CONCLUSION: Bronchoscopic procedures may provide significant therapeutic benefits in severe COVID-19 patients. However, it should be kept in mind that this procedure should only be performed with a rigorous protocol to reduce the risk of aerosol generation and subsequent viral transmission.
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World Health Organization. Novel Coronavirus-China 2020. WHO Bulletin; 2020. Available from: https://www.who.int/docs/ default-source/coronaviruse/situation-reports/20200211-sitrep- 22-ncov.pdf?sfvrsn=fb6d49b1_2. [Last Accessed on 2020 Aug 10].
Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA, et al. The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536-44. https:// doi.org/10.1038/s41564-020-0695-z
World Health Organization. Novel Coronavirus (2019-nCoV) Situation Report-1. Geneva: World Health Organization Bulletin; 2020.
World Health Organization Bulletin. Coronavirus Disease (COVID-19) Situation Report-108. WHO Bulletin; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200507covid-19-sitrep-108. pdf?sfvrsn=44cc8ed8_2. [Last Accessed on 2020 Aug 15].
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. https://doi. org/10.1016/s0140-6736(20)30183-5
Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43. https://doi. org/10.1001/jamainternmed.2020.0994 PMid:32167524
Nay MA, Mankikian J, Auvet A, Dequin PF, Guillon A. The effect of fibreoptic bronchoscopy in acute respiratory distress syndrome: Experimental evidence from a lung model. Anaesthesia. 2016;71(2):185-91. https://doi.org/10.1111/anae.13274 PMid:26559154
Mao Y, Lin W, Wen J, Chen G. Clinical and pathological characteristics of 2019 novel coronavirus disease (COVID-19): A systematic reviews. MedRxiv. 2020;2020:1-31.
Guarracino F, Bertini P, Bortolotti U, Stefani M, Ambrosino N. Flexible bronchoscopy during mechanical ventilation in the prone position to treat acute lung injury. Rev Port Pneumol. 2013;19(1):42-4. https://doi.org/10.1016/j.rppneu.2012.06.005 PMid:22868006
Kabadayi S, Bellamy MC. Bronchoscopy in critical care. BJA Educ. 2017;17(2):48-56. https://doi.org/10.1093/bjaed/mkw040
Pritchett MA, Oberg CL, Belanger A, De Cardenas J, Cheng G. Society for advanced bronchoscopy consensus statement and guidelines for bronchoscopy and airway management amid the COVID-19 pandemic. J Thorac Dis. 2020;12(5):1781-98. https:// doi.org/10.21037/jtd.2020.04.32 PMid:32642084
Wahidi MM, Shojaee S, Lamb CR, Ost D, Maldonado F, Eapen G, et al. The use of bronchoscopy during the COVID-19 pandemic: CHEST/AABIP guideline and expert panel report. Chest. 2020;158(3):1268-81. https://doi.org/10.1016/j.chest.2020.04.036 PMid:32361152
Lentz RJ, Colt H. Summarizing societal guidelines regarding bronchoscopy during the COVID-19 pandemic. Respirology. 2020;25(6):574-7. https://doi.org/10.1111/resp.13824 PMid:32277733
Ashkan MM, Anantham D, Kyle H, Lucia V, Michaela B, Jasleen P, et al. In: Tinku J, editor. International Pulmonologist’s Consensus on COVID-19. 2nd ed. India: Amrita Institute of Medical Science; 2020.
Fehr AR, Perlman S. Coronaviruses: An overview of their replication and pathogenesis. In: Coronaviruses: Methods and Protocols. United States: Humana; 2015. https://doi. org/10.1007/978-1-4939-2438-7_1
Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al. Virology, epidemiology, pathogenesis, and control of covid-19. Viruses. 2020;12(4):1-17. PMid:32230900
Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: Estimation and application. Ann Intern Med. 2020;172(9):577-82. https:// doi.org/10.7326/m20-0504 PMid:32150748
World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report-73. Geneva, Switzerland: World Health Organization Bulletin; 2020.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA. 2020;323(13):1239-42. https://doi.org/10.1001/jama.2020.2648 PMid:32091533
Jamil S, Mark N, Carlos G, Cruz CS, Gross JE, Pasnick S. Diagnosis and management of COVID-19 disease. Am J Respir Crit Care Med. 2020;201(10):P19-20. https://doi.org/10.1164/ rccm.2020c1 PMid:32223716
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/10.1016/ s0140-6736(20)30211-7 PMid:32007143
Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in coronavirus disease 2019 patients: A systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-5. PMid:32173574
Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). Treasure Island, FL: StatPearls; 2020.
Goh KJ, Choong MC, Cheong EH, Kalimuddin S, Duu Wen S, Phua GC, et al. Rapid progression to acute respiratory distress syndrome: Review of current understanding of critical illness from COVID-19 infection. Ann Acad Med Singapore. 2020;49(1):108-18. PMid:32200400
Fanelli V, Vlachou A, Ghannadian S, Simonetti U, Slutsky AS, Zhang H. Acute respiratory distress syndrome: New definition, current and future therapeutic options. J Thorac Dis. 2013;5(3):326-34. PMid:23825769
Meng L, Qiu H, Wan L, Ai Y, Xue Z, Guo Q, et al. Intubation and ventilation amid the COVID-19 outbreak: Wuhan’s experience. Anesthesiology. 2020;132(6):1317-32. https://doi.org/10.1097/ aln.0000000000003296 PMid:32195705
Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159-68. https://doi.org/10.1056/nejmoa1214103 PMid:23688302
Kalchiem-Dekel O, Shanholtz CB, Jeudy J, Sachdeva A, Pickering EM. Feasibility, safety, and utility of bronchoscopy in patients with ARDS while in the prone position. 2018;22:54. https://doi.org/10.1186/s13054-018-1983-3 PMid:29499729
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Copyright (c) 2020 Dewiyana A. Kusmana, Edwin Adhi Darmawan Batubara, Raka Aldy Nugraha, Theresia Rasta Karina, Natasha Setyasty Primaditta (Author)
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