The role of bronchoscopy in patients with sars-cov-2 pneumonia
Arenas-De Larriva, Marisol (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Martín-Deleon, Roberto (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Urrutia Royo, Blanca (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Fernández-Navamuel, Iker (Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz)
Gimenez Velando, Andrés (Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz)
Nuñez García, Laura (Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz)
Centeno, Carmen (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Andreo García, Felipe (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Rafecas-Codern, Albert (Institut d'Investigació Biomèdica Sant Pau)
Fernández-Arias, Carmen (Institut d'Investigació Biomèdica Sant Pau)
Pajares Ruiz, Virginia (Institut d'Investigació Biomèdica Sant Pau)
Torrego, Alfons (Institut d'Investigació Biomèdica Sant Pau)
Rajas, Olga (Hospital Universitario de la Princesa (Madrid))
Iturricastillo, Gorane (Hospital Universitario de la Princesa (Madrid))
Garcia Lujan, Ricardo (Hospital Universitario 12 de Octubre (Madrid))
Comeche Casanova, Lorena (Grupo Quirónsalud (Madrid, Espanya))
Sánchez-Font, Albert (Institut Hospital del Mar d'Investigacions Mèdiques)
Aguilar-Colindres, Ricardo (Hospital del Mar (Barcelona, Catalunya))
Larrosa-Barrero, Roberto (Hospital Universitario Clínico San Carlos (Madrid))
García García, Ruth (Hospital Universitario de Salamanca)
Cordovilla, Rosa (Hospital Universitario de Salamanca)
Núñez-Ares, Ana (Interventional Pulmonology Unit. Pulmonary Dept)
Briones-Gómez, Andrés (Hospital Universitari i Politècnic La Fe (València))
Cases Viedma, Enrique (Hospital Universitari i Politècnic La Fe (València))
Franco, José (INCLIVA Health Research Institute)
Cosano Povedano, Javier (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Rodríguez-Perálvarez, Manuel (IMIBIC. CIBERehd)
Cebrian Gallardo, Jose Joaquin (Agencia sanitaria Costa del Sol)
Nuñez Delgado, Manuel (Hospital Álvaro Cunqueiro (Vigo))
Pavón-Masa, María (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
Valdivia Salas, Maria del Mar (Hospital Universitario Santa Lucía)
Flandes, Javier (Hospital Universitario Fundación Jiménez Díaz)

Date:	2021
Abstract:	Background The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate. Patients and methods This observational multicentre 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 years; 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%). 147 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 hyperaemia (11. 4%). The independent predictors of in-hospital mortality were: older age (OR 1. 06; p<0. 001), mucus plugs as indication for bronchoscopy (OR 1. 60; p=0. 041), absence of mucosal hyperaemia (OR 0. 49; p=0. 041) and the presence of haematic secretions (OR 1. 79; p=0. 032). Conclusion 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.
Note:	Altres ajuts: Sociedad Española de Neumología y Cirugía Torácica (SEPAR, PII 2020).
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	ERJ Open Research, Vol. 7 Núm. 3 (2021) , p. 165-2021, ISSN 2312-0541

DOI: 10.1183/23120541.00165-2021
PMID: 34258257

11 p, 605.0 KB

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