Indications of major bronchoscopy societies.
Several bronchology societies have issued documents regarding
bronchoscopy during the early phase of the COVID-19
pandemic.1,13-16 Based on the risk of aerosol
transmitted infection all societies at that time recommended postponing
elective procedures, limiting the number of procedures in COVID-19
patients, performing procedures in COVID-19 patients with the minimal
sufficient staff and with the use of appropriate personal protective
equipment (PPE). Deciding how to stratify elective procedures to
minimize the risk of transmission while not compromising time-sensitive
medical care has been a major challenge and experts recommended
reviewing the need for all procedures on a case-by-case basis to assess
the indication and urgency.14
Known or suspected COVID-19 infection was considered a relative
contraindication to bronchoscopy, given the uncertain benefit and
possible risks. Bronchoscopy in COVID-19 patients had three main roles:
1) the diagnosis of SARS-Cov-2 infection when other diagnostic tools
were inconclusive; 2) the identification of co-infections or
superinfections in patients with worsening respiratory conditions; 3)
the treatment of bronchoscopic emergencies (massive bleeding,
significant airway stenosis, airway secretions causing tracheobronchial
obstruction etc).
The major bronchoscopy societies agreed on the need of limiting the use
of BAL in the diagnosis of SARS-Cov-2 infection. However, based on the
need to avoid false negatives, the societies made a point for a possible
indication to perform BAL in cases of suspected COVID-19 when other
diagnostic methods were inconclusive and in those situations in which
the identification of coinfections could play an important role in the
therapeutic decision.
None of these bronchology societies indications given during the early
pandemic phase were comprehensive and significant uncertainty remained
regarding in whom to perform bronchoscopy.17 At that
time no data specific to bronchoscopy in COVID-19 were yet available,
and the recommendations were experts’ opinions derived from observations
made during prior respiratory viral outbreaks including other SARS,
Middle east Respiratory Syndrome and influenza. However, in the rapidly
changing clinical environment of the last two years, many centres
equipped with appropriate PPE and experienced in the use of BAL, have
performed BAL in known or suspected COVID-19 infection generating new
evidence on the utility of bronchoscopy in COVID-19 that needs to be
carefully considered.