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Bronchoscopy challenges during the COVID-19 pandemic.
Thomas R Gildea1, Basem B Abdelmalak2
1Departments of Pulmonary Allergy and Critical Care Medicine and Transplant Center, Respiratory Institute, Cleveland Clinic gildeat@ccf.org.
Cleveland Clinic Journal of Medicine
|August 8, 2020
Summary
This study details COVID-19 safety protocols for bronchoscopy, a procedure that generates aerosols. New guidelines prioritize urgent cases and implement enhanced protective measures to minimize virus transmission risks for healthcare providers.
Area of Science:
- Pulmonology
- Infectious Disease Control
- Healthcare Management
Background:
- Bronchoscopy is an aerosol-generating procedure (AGP) posing significant transmission risks for respiratory pathogens like COVID-19.
- The COVID-19 pandemic necessitated immediate changes in healthcare delivery, including the postponement of elective procedures.
- Protecting healthcare providers during AGPs is critical to maintaining healthcare system capacity.
Purpose of the Study:
- To describe the development and implementation of a tiered prioritization system for bronchoscopy procedures during the COVID-19 pandemic.
- To outline the revised protocols implemented to minimize aerosol generation and virus transmission during bronchoscopy.
- To ensure the safety of healthcare providers and patients undergoing bronchoscopy in the context of airborne pathogen risks.
Main Methods:
- Established a 5-tier urgency-based system for prioritizing bronchoscopy cases.
- Implemented enhanced safety protocols, including the use of airborne infection-isolation rooms.
- Transitioned to total intravenous anesthesia and mandated N95 respirator use for all personnel.
- Developed comprehensive guidelines for periprocedural care and personal protective equipment (PPE).
Main Results:
- The 5-tier system allowed for structured prioritization of necessary bronchoscopies.
- Revised protocols effectively addressed aerosolization risks associated with bronchoscopy.
- Mandatory use of airborne infection-isolation rooms, TIVA, and N95 masks significantly reduced potential exposure.
- Guidelines provided a framework for safe periprocedural care and PPE utilization.
Conclusions:
- A multi-faceted approach involving procedural prioritization, environmental controls, anesthesia modifications, and stringent PPE is effective in mitigating COVID-19 transmission risks during bronchoscopy.
- These strategies are essential for the safe resumption of elective bronchoscopies and the protection of healthcare workers.
- The established protocols provide a model for managing aerosol-generating procedures in high-risk infectious disease environments.
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