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

Abstract

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.

Keywords

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

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