![]() When patients are intubated, respiratory specimen collection can include tracheal aspirates and non-bronchoscopic bronchoalveolar lavage. ![]() The collection of upper respiratory samples via nasopharyngeal and oropharyngeal swabs is non-invasive and less contaminating. The American Association of Bronchology and Interventional Pulmonology (AABIP) released a statement that bronchoscopy has a limited diagnostic role in SARS-CoV-2 infected patients, due to substantial risk of contamination. The size of the droplets is inversely proportional to the velocity of the air. Suctioning during bronchoscopy creates air currents, which generate droplets as they move across the surface of the liquid lining of the airways. It seems that the evidence for bronchoscopy to be listed as an AGP by the World Health Organization is based on a study comparing the rate of tuberculin skin test conversion among pulmonology and infectious diseases fellows graduating in 1983 during a resurgence of tuberculosis in the United States. They could not demonstrate increased viral RNA during bronchoscopy. Thompson et al measured the amount of viral RNA in the air in the vicinity of H1N1 positive patients during bronchoscopy and compared it to controls. In this study the risk during bronchoscopy did not reach significance (pooled OR 1.3, 95% CI 0.5, 14.2). This study demonstrated with a univariate analysis, that in HCWs working with SARS-CoV-1 patients, 6/85 cases (who had IgG against SARS-CoV-1) versus 11/646 controls (who did not have IgG against SARS-CoV-1) had performed tracheostomies during the epidemic (odds ratio 4.15, 95% CI 2.75, 7.54). Only one case-control study about the risk for front-line HCWs caring for SARS-CoV-1 patients has been performed and in this study, conducted in China, tracheostomies were performed by HCWs. Limited information is available about the risk for front-line workers during previous viral pandemics. ![]() The first SARS-CoV-2 transmission to an HCW was described in January 2020 and the first reported HCW death related to SARS-CoV-2 was an otolaryngologist from Wuhan, China. Airway procedures result in the aerosolisation of SARS-CoV-2 placing HCWs at high risk of getting infected,. The airways of SARS-CoV-2 infected patients contain a very high viral load. The use of bronchoscopy is associated with increased risk of patient-to-health care worker (HCW) transmission, due to aerosolised viral particles, which may be inhaled but also results in environmental contamination of surfaces during bronchoscopy,. Aerosol generating procedures (AGPs) pose the greatest risk of transmission. SARS-CoV-2 spreads primarily through respiratory droplets and microdroplets generated by the infected person, although aerosol transmission may also occur. Since the start of the outbreak in December 2019 there is an ever-increasing number of infections worldwide. The emergence and rapid global spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) resulting in Coronavirus Disease 2019 (COVID-19) initially reported in Wuhan, China has been well documented. When anaesthetic and infection prevention control protocols are strictly adhered to, bronchoscopy can be performed in SARS-CoV-2 positive children. Modified full face masks are a practical and safe alternative to filtering facepieces for use in bronchoscopy. Adequate personal protection equipment is key, as is training of health care workers in correct donning and doffing. When rigid bronchoscopy is necessary, jet ventilation must be avoided and conventional ventilation be used to reduce the risk of aerosolisation. When available single-use flexible bronchoscopes may be considered for use devices are available with a range of diameters, and improved image quality and degrees of angulation. Flexible bronchoscopy should be performed first in SARS-CoV-2 positive individuals or in unknown cases, to determine if rigid bronchoscopy is indicated. ![]() During the SARS-CoV-2 pandemic rigid bronchoscopy should be avoided due to the increased risk of droplet spread. Bronchoscopy is not appropriate for diagnosing SARS-CoV-2 infection and, as an aerosol generating procedure involving a significant risk of transmission, has a very limited role in the management of SARS-CoV-2 infected patients including children. As the airways of SARS-CoV-2 infected patients contain a high viral load, bronchoscopy is associated with increased risk of patient to health care worker transmission due to aerosolised viral particles and contamination of surfaces during bronchoscopy. ![]()
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