Table 1.

Bronchoscopy in intubated COVID+ patients

Indications and benefits

Secretion management

Radiological worsening, nosocomial overinfection

Hemoptysis

Artificial airway management (orotracheal tube position, difficult intubation, tracheostomy guidance)

Potential risk

Respiratory deterioration

Staff contamination

Findings

Normal mucosa or hyperemia (frequent)

Mucous plugs, thick jelly secretions (frequent)

Blood clots (infrequent)

Recommended procedures

Direct suction

Instillation of mucoactive agents for secretions (hypertonic saline, hyaluronic acid, N-acetylcysteine, rhDNAse)

Mini-BAL for microbiological studies

Practical tips for safe, effective, and shortest duration bronchoscopic sampling a. Check all equipment is ready − see checklist b. 100% FiO2, +/– ECMO flow/sweep gas increase for the procedure c. Neuromuscular paralysis for bronchoscopy unless contraindicated d. Staff check of personal protective equipment and set FiO2 at 1.0 e. Pre-prepare the bronchoscope/sampler/catheter mount  1 Connect the bronchosampler to the scope; connect the scope to a view monitor  2 Put the tip of the bronchoscope into the catheter mount  3 Prior to exchanging the catheter mount, tube clamp and perform an inspiratory hold on the ventilator during circuit breaks  4 See the simple instruction for the bronchosampler  5 At completion, DO NOT remove the bronchoscope; withdraw the tip into the end of the catheter mount; clamp the endotracheal tube, inspiratory hold, then quick circuit change, unclamp, and resume ventilation