Society for Advanced Bronchoscopy Consensus Statement and Guidelines for bronchoscopy and airway management amid the COVID-19 pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly emerging zoonotic virus that was initially identified in Wuhan City, Hubei Province, China on December 30, 2019 and spread rapidly via human-to-human transmission chains that existed before containment control measures were implemented. At the time of this writing, cases of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, have been reported in 184 countries (https://coronavirus.jhu.edu/map.html), leading to the outbreak being classified as a pandemic by the World Health Organization (WHO) on March 11, 2020 (1). COVID-19 infection, in many cases, requires specialized airway management in intensive care units (ICU). Similar to the SARS pandemic in 2003, this viral infection appears to be a highly transmissible pathogen in healthcare environments, including transmission to healthcare personnel. As the COVID-19 pandemic evolves worldwide, healthcare systems and providers struggle to strike a balance between providing medical care to those in need while limiting disease spread and exposure to patients and staff. The Society for Advanced Bronchoscopy (SAB) has formulated guidelines regarding bronchoscopy and airway management in this setting in an effort to summarize the currently available information and provide practical, evidence-based recommendations for those caring for or being asked to consider performing these high-risk procedures. Members of the SAB established a panel of practitioners, prioritized current challenges in the field to effectively respond to the pandemic, agreed on group processes, and provided full declaration of conflicts of interest. In preparing this document, and to the best of our knowledge, we performed an in-depth review of existing medical literature. We subsequently developed sequential evaluations of the quality of evidence across studies for specific situations that we may encounter as advanced bronchoscopists and interventional pulmonologists. We based the grade of recommendation on the quality of supporting evidence and the balance between benefits and harms (Table 1) (2). Table 1 Grade of recommendation based on the quality of supporting evidence Grade Strength Evidence quality Descriptor 1A Strong recommendation High Existing well-performed randomized controlled trials with overwhelming evidence of benefit 1B Strong recommendation Moderate Existing randomized controlled trials with important limitations 1C Strong recommendation Low Evidence obtained from observational studies, nonsystematic clinical experience with significant potential benefit and low risk of harm 2A Weak recommendation High Existing randomized trials but the ratio of benefit and risk is closely balanced; further evidence is unlikely to change our confidence on this ratio 2B Weak recommendation Moderate Existing randomized trials with important flaws and the ratio of benefit and risk is closely balanced; further evidence is unlikely to change our confidence on this ratio 2C Weak recommendation Low Existing observation studies, nonsystematic clinical experience, or controlled trials with serious flaw in their design; any estimate of effect is unclear Open in a separate window In this rapidly changing public health environment, we also acknowledge that best practices may vary amongst institutions based on local resources, expertise, patient populations, and continual updating of recommendations from major health organizations such as the US Centers for Disease Control and Prevention (www.cdc.gov) and the WHO (www.who.int). Therefore, we are planning to update the protocols and recommendations outlined here (www.sabronchoscopy.org) as we inevitably learn new information that will affect our practices and procedures. We are also planning to evaluate our recommendations in terms of their applicability and barriers to their implementation.