Management of acute respiratory deterioration in the Intensive care ünit during the covid-19 pandemic: Prospective analysis of retrospective data collected from a tertiary intensive care unit

Yıl 2024, Cilt: 41 Sayı: 3, 595 - 599, 30.09.2024

Ebru Kaya , Özcan Kaya , Serkan Doğan , Ayça Sultan Şahin

Öz

Coronavirus disease-2019 (COVID) is a highly contagious viral disease, spread predominantly by airborne particles. Due to the high dissemination risk of COVID-19, aerosol generating procedures such as orotracheal intubation and bronchoscopy may result in viral spread. Therefore, performing bronchoscopies in infected patients, with insufficient evidence, is controversial. The aim of this study was to assess the requirements for emergency bronchoscopy in COVID-19 patients treated with invasive mechanical ventilation in the ICU, and to evaluate the applicability of the procedure and its effects on clinical progress. Patients with confirmed COVID-19 diagnoses who received invasive mechanical ventilation in the intensive care unit between March 26, 2020 and February 1, 2021, and who underwent emergency bronchoscopy were included into the study. Respiratory parameters before and after the procedure were analyzed with the paired t test. Among 395 patients diagnosed with COVID-19 pneumonia who received mechanical ventilation, 45 (mean age:48, 17F/28M) underwent an emergency bronchoscopy. The major indication for bronchoscopy was forced mechanical ventilation that did not respond to different measures. In 91.6% of the bronchoscopies there were positive findings, the most common were mucus secretions (82.4%), hematoma secretions (17.7%), mucous plugs (17.6%), and extensive mucosal hyperemia (11.4%). Patients who underwent bronchoscopies were noted to have significant improvements in respiratory mechanics and PO2/FiO2 ratios (p<0.05). Bronchoscopy can be safely applied in COVID-19 patients to solve the complications of mechanical ventilation, provided that the rules of personal protective equipment are complied with. Immediate improvements in respiratory parameters can be attained with bronchoscopy. In the absence of X ray findings, causes of the acute respiratory deterioration in COVID-19 patients can be investigated with bronchoscopy.

Anahtar Kelimeler

covid-19 pandemic, adult respiratory distress syndrome, critical care, bronchoscopy, occupation safety

Kaynakça

• World Health Organization. Novel coronavirus — China. January 12, 2020. (http://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/).
• Center for Systems Science and Engineering. Coronavirus COVID-19 global cases. 2019.
• Jin F, Mu D, Chu D, Fu E, Xie Y, Liu T. Severe complications of bronchoscopy. Respiration. 2008; 76: (4) 29–433
• Lentz RJ, Colt H. Summarizing societal guidelines regarding bronchoscopy during the COVID-19 pandemic. Respirology. 2020 Jun; 25(6):574-577.
• Tran K, Cimon K, Severn M, Pessoa Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012; 7(4): e35797
• Torrego A, Pajares V, Fernández-Arias C, Vera P, Mancebo J. Bronchoscopy in Patients with COVID-19 with Invasive Mechanical Ventilation: A Single-Center Experience. Am J Respir Crit Care Med. 2020 Jul 15; 202(2):284-287.
• Wahidi MM, Lamb C, Murgu S, Musani A, Shojaee S, Sachdeva A, et al. American Association for Bronchology and Interventional Pulmonology (AABIP) Statement on the Use of Bronchoscopy and Respiratory Specimen Collection in Patients With Suspected or Confirmed COVID-19 Infection. G J Bronchology Interv Pulmonol. 2020 Oct; 27(4):e52-e54.
• Peng YD, Meng K, Guan HQ, Leng L, Zhu RR, Wang BY, et al. [Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV]. Zhonghua Xin Xue Guan Bing Za Zhi. 2020 Jun 24;48(6):450-455. Chinese.
• Marini JJ, Gattioni L. Management of COVID-19 respiratory distress. JAMA. 2020. (in press). doi:10.1001/jama.2020.6825
• Gattioni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D. Covid-19 does not lead to a “typical” acute respiratory distress syndrome. AJRCCM. 2020. (in press). doi: 10.1164/rccm.202003-0817LE
• Gattioni L, Chiumello D, Rossi S. COVID-19 pneumonia: ARDS or not?. BMC Critical Care. 2020; 24:154.
• Chan JYK, Wong EWY, Lam W. Practical aspects of otolaryngologic clinical services during the 2019 novel coronavirus epidemic: an experience in Hong Kong. JAMA Otolaryngol Head Neck Surg. 2020;146(6):519‐520.
• Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS‐CoV‐2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020; 382:1177‐1179
• Houghton C, Meskell P, Delaney H, Smalle M, Glenton C, Booth A, et al. Barriers and facilitators to healthcare workers' adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database Syst. Rev. 2020; 4: CD013582.
• Earhart AP, Holliday ZM, Hofmann HV, Schrum AG. Consideration of dornase alfa for the treatment of severe COVID-19 acute respiratory distress syndrome. New Microbes New Infect. 2020;35doi: 10.1016/j.nmni.2020.100689.
• Ansarin K, Tolouian R, Ardalan M, Taghizadieh A, Varshochi M, Teimouri S, et al. Effect of bromhexine on clinical outcomes and mortality in COVID-19 patients: A randomized clinical trial. Bioimpacts. 2020; 10(4):209-215.