Bronchoscopy in COVID-19 patients: When, how and why. Experience in clinical practice

Utility of bronchoalveolar lavage for COVID-19: a perspective from the Dragon consortium

Diagnosing COVID-19 and treating its complications remains a challenge. This review reflects the perspective of some of the Dragon (IMI 2-call 21, #101005122) research consortium collaborators on the utility of bronchoalveolar lavage (BAL) in COVID-19. BAL has been proposed as a potentially useful diagnostic tool to increase COVID-19 diagnosis sensitivity. In both critically ill and non-critically ill COVID-19 patients, BAL has a relevant role in detecting other infections or supporting alternative diagnoses and can change management decisions in up to two-thirds of patients. BAL is used to guide steroid and immunosuppressive treatment and to narrow or discontinue antibiotic treatment, reducing the use of unnecessary broad antibiotics. Moreover, cellular analysis and novel multi-omics techniques on BAL are of critical importance for understanding the microenvironment and interaction between epithelial cells and immunity, revealing novel potential prognostic and therapeutic targets. The BAL technique has been described as safe for both patients and healthcare workers in more than a thousand procedures reported to date in the literature. Based on these preliminary studies, we recognize that BAL is a feasible procedure in COVID-19 known or suspected cases, useful to properly guide patient management, and has great potential for research.

Severe Thrombocytopenia as a Manifestation of COVID-19 Infection

Clinical manifestations of COVID-19 infection can range from an asymptomatic clinical form to acute respiratory distress depending on the virus gateway, viral load, host immunity, and existing comorbidities. Some patients with COVID-19 infection can present hematological changes depending on the patient’s immune response and the severity of the infection. We present two different manifestations of thrombotic disorders related to COVID-19: one severe form of immune thrombocytopenia in a young woman with no comorbidities and a severe form of thrombocytopenia along with disseminated intravascular coagulation and acute urinary obstructive disease. Interestingly, both patients presented no signs of COVID-19 pneumonia. Failure to diagnose thrombocytopenia rapidly may lead to severe complications. Management with immunosuppressive corticosteroids in high doses should carefully balance the risk of bleeding versus deterioration due to infection.

Bronchoscopy During Coronavirus Disease 2019 Pandemic: A Bronchoscopist's Perspective

Bronchoscopy is a safe and commonly performed procedure for diagnostic as well as therapeutic indications. Bronchoscopy is also an aerosol-generating procedure, and due to the risk of severe acute respiratory syndrome coronavirus 2 transmission during the procedure, routine bronchoscopy has been discouraged by multiple professional societies, despite any solid evidence. There are only a few reports of bronchoscopy in patients with coronavirus disease 2019 in the literature. Bronchoscopy in this patient population plays a crucial role not only in the diagnosis of coronavirus disease 2019 but also in the identification of secondary bacterial or fungal infections and in directing appropriate antimicrobial therapy. Bronchoscopy with therapeutic interventions may be lifesaving. Based on the literature, the risk of coronavirus disease 2019 transmission appears to be low among bronchoscopists and other healthcare workers when appropriate personal protective equipment is used. Bronchoscopy in patients with coronavirus disease 2019 should be strongly considered when clinically indicated.