FIBER-OPTIC BRONCHOSCOPY IN PATIENTS INFECTED WITH COVID-19: A CASE SERIES

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Bronchoscopy is a safe diagnostic and therapeutic tool Considering the increased number of COVID-19 cases worldwide, several associations issued guidelines regarding performance of bronchoscopy in patients with suspected/confirmed infection We present a series of patients with COVID-19 who underwent bronchoscopy METHODS: Retrospective review of patients admitted to BronxCare Health Hospital from April to May 2020 who had COVID-19 pneumonia and required emergent/urgent bronchoscopy We included only patients with positive nasopharyngeal swab test (SARS Coronavirus with CoV-2 RNA, Qual RT-PCR) Demographics and clinical- radiological information was obtained A safety check list was created which included all features recommended in current guidelines The additional recommendations included: bronchoscopy should be performed with patients sedated on ventilator;Stryker’s Hood Flyte Peel Away to be used to complement standard PPE;ventilator placed on stand-by every time patient is disconnected ie to connect/remove bronchoscopy adaptor, to insert/remove bronchoscope Once scope has been introduced into the airway, the procedure should be expedited as quickly as possible to minimize withdrawal and reintroduction of scope RESULTS: Six patients underwent bronchoscopy, 67% males, mean age 43 (range 29-80 years old) All patients had bilateral infiltrates on CXR Mean time from initial symptoms to bronchoscopy was 33 5 days (range 2-73 days) One patient was intubated for the bronchoscopy;the remaining 5 were on mechanical ventilator for respiratory failure Indication for bronchoscopy was lung collapse in 2 and persistent sepsis and fever despite antibiotics and negative cultures in the remainder 4 patients Bronchoscopy with bronchoalveolar lavage (BAL) was performed in all patient BAL fluid tested positive for SARS Coronavirus in 4 patients and 3 patients had positive bacterial cultures including identification of a multi-drug resistant pathogen The lung expanded in patients with collapse and change in antibiotics was done in 50% of patients based in BAL results Checklist was followed for all bronchoscopies;all personnel involved were followed for three weeks with daily temperature checks and symptoms monitoring Nobody has shown any symptoms of COVID-19 infection;neither had prior infection CONCLUSIONS: Bronchoscopy in patients infected with COVID-19, performed following strict safety measures are potentially safe and can help with patient care Emergency/ urgent procedures should not be delayed as bronchoscopy could change management in those patients Implications of finding positive BAL for COVID-19 are unclear but patients potentially are still infective CLINICAL IMPLICATIONS: We suggest careful evaluation of risk versus benefit of the bronchoscopy and strict, simple and standardized techniques for procedure performance in order to minimize risk of transmission DISCLOSURES: No relevant relationships by Gilda Diaz-Fuentes, source=Web Response No relevant relationships by Gabriella Roa Gomez, source=Web Response No relevant relationships by Sindhaghatta Venkatram, source=Web Response