The role of bronchoscopy in patients with SARS-CoV-2 pneumonia
- Marisol Arenas-De Larriva1,
- Roberto Martín-DeLeon2,
- Blanca Urrutia Royo3,
- Iker Fernández-Navamuel4,
- Andrés Gimenez Velando4,
- Laura Nuñez García4,
- Carmen Centeno Clemente5,
- Felipe Andreo García5,
- Albert Rafecas Codern6,
- Carmen Fernández-Arias6,
- Virginia Pajares Ruiz6,
- Alfons Torrego Fernández6,
- Olga Rajas7,
- Gorane Iturricastillo8,
- Ricardo Garcia Lujan9,
- Lorena Comeche Casanova10,
- Albert Sánchez-Font11,
- Ricardo Aguilar-Colindres12,
- Roberto Larrosa-Barrero13,
- Ruth García García14,
- Rosa Cordovilla14,
- Ana Núñez-Ares15,
- Andrés Briones-Gómez16,
- Enrique Cases Viedma16,
- José Franco17,
- Javier Cosano Povedano18,
- Manuel Luis Rodríguez-Perálvarez19,
- Jose Joaquin Cebrian Gallardo20,
- Manuel Nuñez Delgado21,
- María Pavón-Masa22,
- Mª del Mar Valdivia Salas23 and
- Javier Flandes24
- 1Department of Bronchoscopy and Interventional Pulmonology, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
- 2Department of Pulmonology, Hospital Universitario Reina Sofía, IMIBIC., Córdoba, Spain
- 3Pulmonary Department. Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol., Badalona, Spain
- 4Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Department, Hospital Fundacion Jimenez Diaz, ISS-FJD, CIBERES., Madrid, Spain
- 5Interventional Pulmonology Unit, Pulmonary Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, UAB, IGTP., Badalona, Spain
- 6Respiratory Department, Hospital Santa Creu i Sant Pau., Barcelona, Spain
- 7Interventional Pulmonology Unit, Pulmonology Department, Hospital Universitario de la Princesa, Instituto de Investigación Princesa., Madrid, Spain
- 8Pulmonology Department, Hospital Universitario de la Princesa, Instituto de Investigación Princesa., Madrid, Spain
- 9Department of Interventional Pulmonology, Hospital Universitario 12 Octubre and Hospital Univesitario Quirónsalud Madrid., Madrid, Spain
- 10Department of Pulmonology, Hospital Universitario Quirónsalud Madrid., Madrid, Spain
- 11Pulmonology Department, Hospital del Mar, CIBERES, UAB, IMIM (Hospital del Mar Medical Research Institute)., Barcelona, Spain
- 12Pulmonology Department, Hospital del Mar, CIBERES., Barcelona, Spain
- 13Pulmonary Department, Hospital Universitario Clínico San Carlos., Madrid, Spain
- 14Interventional Pulmonology Unit, Pulmonary Department, Salamanca University Hospital., Salamanca, Spain
- 15Interventional Pulmonology Unit, Pulmonary Department., Hermanos Falcó s/n, Albacete, Spain
- 16Interventional Pulmonology Unit, Pulmonary Department, Hospital Universitario y Politécnico La Fe., Valencia, Spain
- 17Pneumology Service, Clinic University Hospital, INCLIVA Health Research Institute., Valencia, Spain
- 18Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Department, Hospital Universitario Reina Sofía, IMIBIC., Córdoba, Spain
- 19Maimónides Institute of Biomedical Research of Córdoba (IMIBIC), CIBERehd, Córdoba (Spain)., Córdoba, Spain
- 20Department of pulmonology, Agencia sanitaria Costa del Sol., Marbella, Spain
- 21Department of bronchoscopy and Interventional Pulmonology, Hospital Álvaro Cunqueiro, CHUVI., Vigo, Spain
- 22Department of Interventional Pulmonology, Hospital Universitario Virgen Macarena., Sevilla, Spain
- 23Department of Interventional Pulmonology, Hospital Universitario Santa Lucía., Cartagena, Spain
- 24Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Department, Hospital Fundación Jimenez Diaz, ISS-FJD, CIBERES., Madrid, Spain
- Marisol Arenas De Larriva, Hospital Universitario Reina Sofía. Avda. Menéndez Pidal s/n, Postal code 14004, Córdoba, Spain. E-mail: arlam23{at}hotmail.com
Abstract
Background The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate. Patients and methods: This observational multicenter study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June, 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression.
Results A total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). One hundred forty-seven bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperemia (11.4%). The independent predictors of in-hospital mortality were: older age (Odds ratio [OR]=1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR=1.60; p=0.041), absence of mucosal hyperemia (OR=0.49; p=0.041) and the presence of haematic secretions (OR=1.79; p=0.032).
Conclusions Bronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19.
Footnotes
This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.
Conflict of interest: M. Arenas-De Larriva reports a travel grant from Novartis and lecture fees from Ferrer outside the submitted work.
Conflict of interest: Dr. Martin-Deleon has nothing to disclose.
Conflict of interest: Dr. Urrutia Royo has nothing to disclose.
Conflict of interest: Dr. Fernandez-Navamuel has nothing to disclose.
Conflict of interest: Dr. Andrés Gimenez Velando has nothing to disclose.
Conflict of interest: Dr. Laura Nuñez García has nothing to disclose.
Conflict of interest: Dr. CENTENO CLEMENTE has nothing to disclose.
Conflict of interest: Dr. Andreo García has nothing to disclose.
Conflict of interest: Dr. Albert Rafecas Codern has nothing to disclose.
Conflict of interest: Dr. Fernández-Arias has nothing to disclose.
Conflict of interest: Dr. PAJARES has nothing to disclose.
Conflict of interest: Dr. Torrego Fernández has nothing to disclose.
Conflict of interest: Dr. RAJAS has nothing to disclose.
Conflict of interest: Dr. Iturricastillo has nothing to disclose.
Conflict of interest: Dr. GARCIA LUJAN has nothing to disclose.
Conflict of interest: Dr. Comeche Casanova has nothing to disclose.
Conflict of interest: Dr. Sánchez-Font has nothing to disclose.
Conflict of interest: Dr. Aguilar-Colindres has nothing to disclose.
Conflict of interest: Dr. Larrosa-Barrero has nothing to disclose.
Conflict of interest: Dr. Ruth García García has nothing to disclose.
Conflict of interest: Dr. Cordovilla has nothing to disclose.
Conflict of interest: Dr. Núñez-Ares has nothing to disclose.
Conflict of interest: Dr. Andrés Briones-Gómez has nothing to disclose.
Conflict of interest: E. Cases Viedma reports lecture fees from Ambu outside the submitted work.
Conflict of interest: Dr. Franco has nothing to disclose.
Conflict of interest: J. Cosano Povedano report a travel grant from Izasa scientific outside the submitted work.
Conflict of interest: Manuel Luis Rodríguez-Perálvarez reports lecture fees from Novartis, Astellas and Intercept outside the submitted work.
Conflict of interest: Dr. Jose Joaquin Cebrian Gallardo has nothing to disclose.
Conflict of interest: Dr. Nuñez Delgado has nothing to disclose.
Conflict of interest: Dr. María Pavón-Masa has nothing to disclose.
Conflict of interest: Mª del Mar Valdivia Salas has nothing to disclose.
Conflict of interest: Dr. FLANDES has nothing to disclose.
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- Received March 9, 2021.
- Accepted April 21, 2021.
- Copyright ©The authors 2021
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