COVID-19

CHEST/AABIP Publish Guideline for Bronchoscopy Use During Current Pandemic

The American College of Chest Physicians (CHEST) and the American Association for Bronchology and Interventional Pulmonology (AABIP) have developed a guideline for the use of bronchoscopy during the coronavirus disease 2019 (COVID-19) pandemic. 

“Transmission [of COVID-19] is generally via respiratory droplets, but airborne transmission may be possible with aerosol-generating procedures (AGP) such as bronchoscopy,” the guideline authors wrote. “Therefore, bronchoscopy and other AGP put health care workers at particularly high risk of exposure and infection.”

To examine the current evidence on the role of bronchoscopy during the COVID-19 pandemic and the optimal protection of patients and health care workers, the panel of experts systematically searched the MEDLINE database for relevant literature and references.

Based on the review and critical analysis, the panel developed 1 evidence-based graded recommendation and 5 ungraded consensus-based statements. 

The Grade 2C recommendation is that bronchoscopy should be performed in a timely and safe manner when bronchoscopy is indicated to diagnose, stage, or characterize a known or suspected lung cancer in an area where community transmission of COVID-19 is present.

The ungraded consensus-based statements are as follows:

  1. Health care workers in the procedure and recovery rooms should use either an N-95 respirator or a powered air-purifying respirator when patients with suspected or confirmed COVID-19 infection are undergoing bronchoscopy.
  2. Obtain a nasopharyngeal specimen first from patients suspected of having COVID-19 infection. In the setting of severe or progressive disease requiring intubation, if additional specimen is needed to establish a diagnosis of COVID-19 or other diagnosis that will change clinical management, lower respiratory specimens from endotracheal aspirate or bronchoscopy with bronchoalveolar lavage can be performed.  
  3. Health care workers in the procedure room should wear N-95 respirators or powered air-purifying respirators rather than surgical masks when asymptomatic patients present for bronchoscopy in an area where community spread of COVID-19 is present.
  4. Prior to performing bronchoscopy in asymptomatic patients in an area where community transmission of COVID-19 infection is present, test for COVID-19 infection. 
  5. For patients with confirmed COVID-19 infection who recover and need a routine bronchoscopy, the timing of the procedure should be customized based on the indication for the procedure, the severity of the COVID-19 infection, and time from symptom resolution.

“We would like to stress that these protective strategies can be rendered completely ineffective if proper training on donning and doffing is not provided to [health care workers],” the authors wrote. “Proper personnel instruction and practice for wearing [personal protective equipment] should receive as much attention by health facilities as the chosen strategy for protection.”

—Colleen Murphy

Reference:

Wahidi MM, Shojaee S, Lamb CR, et al. The use of bronchoscopy during the COVID-19 pandemic: CHEST/AABIP guideline and expert panel report. CHEST. Published online April 30, 2020. doi:10.1016/j.chest.2020.04.036