The role of bronchoscopy in patients with SARS-CoV-2 pneumonia
Marisol Arenas‐De Larriva, Roberto Martin-Deleon, Blanca Urrutia Royo, Iker Fern�ndez-Navamuel, Andr�s Gimenez Velando, Laura Nu�ez Garc�a, Carmen Centeno Clemente, Felipe Andreo García, A Rafecas, Carmen Fern�ndez-Arias, Virginia Pajares, Alfons Torrego Fernández, Olga Rajas, Gorane Iturricastillo, Ricardo García Luján, Lorena Comeche Casanova, Albert S�nchez-Font, Ricardo Aguilar-Colindres, Roberto Larrosa-Barrero, Ruth García García, Rosa Cordovilla, Ana Núñez-Ares, Andr�s Briones-G�mez, Enrique Cases Viedma, José R. Franco, Javier Cosano Povedano, Manuel Rodríguez‐Perálvarez, José Joaquín Cebrián Gallardo, M. Núñez Delgado, Mar�a Pav�n-Masa, María del Mar Valdivia Salas, Javier Flandes
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.