Bronchoscopic Intervention May be Associated with Better Outcomes in Mechanically Ventilated Coronavirus Disease-19 Patients: A Case Series

Dewiyana A. Kusmana; Edwin Adhi Darmawan Batubara; Raka Aldy Nugraha; Theresia Rasta Karina; Natasha Setyasty Primaditta

doi:10.3889/oamjms.2020.5390

Authors

Dewiyana A. Kusmana Department of Pulmonology, Pulmonologist, Gatot Soebroto Army Hospital, Jakarta, Indonesia
Edwin Adhi Darmawan Batubara Department of General Practice, Mintohardjo Navy Hospital, Jakarta, Indonesia
Raka Aldy Nugraha Department of General Practice, Depok University of Indonesia Hospital, Jakarta, Indonesia
Theresia Rasta Karina Department of General Practice, Gatot Soebroto Army Hospital, Jakarta, Indonesia
Natasha Setyasty Primaditta Department of General Practice, Gatot Soebroto Army Hospital, Jakarta, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.5390

Keywords:

Coronavirus disease-19, Acute respiratory distress syndrome, Bronchoscopy intervention

Abstract

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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