Bronchoscopy in COVID-19

Gurmeet Singh, MD
COVID-19 Overview
• A new emerging disease still being studied throughout the world

• Transmitted by droplets (human-to-human) within 1-2 meters

• Can be airborne if induced by aerosol-generating procedures:

bronchoscopy, endotracheal intubation, upper gastrointestinal
endoscopy, tracheostomy, otolaryngeal procedures, dental
procedures, and nebulizer therapy

Pritchett MA et al. J Thorac Dis. 2020

COVID-19
• Size of virion is 125-244 microns

• Etiology: SARS-CoV2

• Respirators (N95) protect against

95% of particles larger than 0.3
microns

Pritchett MA et al. J Thorac Dis. 2020

 Diagnostic Methods:

• RT-PCR (molecular)

• Rapid Test (serology)

Bronchosocopy
• The most common procedure conducted in critical care settings

• Gives direct visualization of the airway

• Used in diagnosis and treatment of airway diseases

Kadabayi S et al. BJA edu. 2017; 17(2): 48-55

All societies recommend postponing elective procedures and
reducing/limiting personnel participating in the procedure to minimize
personal protective equipment (PPE) usage and prevent exposure to
droplets or aerosols

Pritchett MA et al. J Thorac Dis. 2020

Respiratory Societies
• CMA: Chinese Medical Association
• AABIP: American Association for Bronchology and Interventional
Pulmonology
• DGP: German Respiratory Society
• SEPAR: Spanish Society of Pulmonology and Thoracic Surgery
• AABE: Argentinian Association for Bronchology

Pritchett MA et al. J Thorac Dis. 2020

Pritchett MA et al. J Thorac Dis. 2020
Pritchett MA et al. J Thorac Dis. 2020
Screening for Outpatient Bronchoscopy
Temperature
- Fever, cough, sore <37.50C do
throat procedure
- Close contact with NO
suspicious or Temperature
confirmed COVID-19 >37.50C delay
case procedure
- Visited or currently
live in areas at higher DELAY
risk of COVID-19 YES PROCEDURE
(ALL IN PAST 14 DAYS)

Pritchett MA et al. J Thorac Dis. 2020

 When to do Bronchoscopy?

Pritchett MA et al. J Thorac Dis. 2020

Personal Protective Equipment (PPE) Recommendations

Pritchett MA et al. J Thorac Dis. 2020

 Single Use (Disposable) Flexible Bronchoscope
Advantages: avoids reprocessing equipment, minimal personnel
involved, less equipment involved in set-up, transport, and post-
procedure disinfection

Pritchett MA et al. J Thorac Dis. 2020

Single use flexible bronchoscope (A and B) compared to traditional flexible bronchoscope set-up
Pritchett MA et al. J Thorac Dis. 2020
Pritchett MA et al. J Thorac Dis. 2020