Role of Bronchoscopy During SARS-CoV-2 Outbreak in Italy: A Retrospective, Multicenter Study

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been spreading throughout Italy since February 2020. Limited data are available regarding indications, performance characteristics and safety of bronchoscopy (which is an aerosol generating procedure) in the context of SARS-CoV-2 outbreak. Methods: We performed a prospective, observational, multicentric study to describe the role of bronchoscopy during SARS-CoV-2 outbreak in Italy. Findings: 147 consecutive adult patients who underwent bronchoscopy between March 1st and April 15 th 2020 in five Italian hospitals were enrolled. 78/147 (53·1%) bronchoscopies were performed to detect SARS-CoV-2 in patients with negative nasopharyngeal swabs. SARS-CoV-2 was detected in 43/78 (55·1%) patients, without no difference in diagnostic yield between bronchoalveolar lavage (BAL) and bronchial washing (BW) (35/61, 57·4% and 8/17, 47·1%; p-value: 0·45). Suspected co-infections and management of obstructive atelectasis were the main indications for bronchoscopy in 31/147 (21·1%) patients with COVID-19 (respectively 11/31 (35·5%) and 7/31 (16·1%)). Suspected non-COVID-19 lower respiratory tract infections (18/38 (47·4%) and malignancy (7/38 (18·4%)) were the main indications in 38/147 (25·8%) patients without COVID-19. Overall, bronchoscopy was successfully performed for diagnostic and therapeutic purposes in 111/147 (75·5%) cases. 8/147 (5·4%) patients had mild complications related to the procedure.No procedure-related infections for patients and healthcare workers were recorded. Interpretation: bronchoscopy is a useful technique in the diagnosis of SARS-CoV-2 pneumonia in patients with negative swab. Endoscopic techniques may be safely and successfully performed for diagnostic and therapeutic purposes in the vast majority of the patients with or without SARS-CoV-2 illness. Funding: University of Milan Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The study protocol was approved by the ethical committees of all the participating hospitals. Written informed consent was signed by recruited patients