Chest
Volume 158, Issue 3, September 2020, Pages 1268-1281
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Thoracic Oncology: Guideline and Consensus Statement
The Use of Bronchoscopy During the Coronavirus Disease 2019 Pandemic: CHEST/AABIP Guideline and Expert Panel Report

https://doi.org/10.1016/j.chest.2020.04.036Get rights and content

Background

The coronavirus disease 2019 (COVID-19) has swept the globe and is causing significant morbidity and mortality. Given that the virus is transmitted via droplets, open airway procedures such as bronchoscopy pose a significant risk to health-care workers (HCWs). The goal of this guideline was to examine the current evidence on the role of bronchoscopy during the COVID-19 pandemic and the optimal protection of patients and HCWs.

Study Design and Methods

A group of approved panelists developed key clinical questions by using the Population, Intervention, Comparator, and Outcome (PICO) format that addressed specific topics on bronchoscopy related to COVID-19 infection and transmission. MEDLINE (via PubMed) was systematically searched for relevant literature and references were screened for inclusion. Validated evaluation tools were used to assess the quality of studies and to grade the level of evidence to support each recommendation. When evidence did not exist, suggestions were developed based on consensus using the modified Delphi process.

Results

The systematic review and critical analysis of the literature based on six PICO questions resulted in six statements: one evidence-based graded recommendation and 5 ungraded consensus-based statements.

Interpretation

The evidence on the role of bronchoscopy during the COVID-19 pandemic is sparse. To maximize protection of patients and HCWs, bronchoscopy should be used sparingly in the evaluation and management of patients with suspected or confirmed COVID-19 infections. In an area where community transmission of COVID-19 infection is present, bronchoscopy should be deferred for nonurgent indications, and if necessary to perform, HCWs should wear personal protective equipment while performing the procedure even on asymptomatic patients.

Key Words

bronchoscopy
COVID-19
personal protective equipment

Abbreviations

AABIP
American Association for Bronchology and Interventional Pulmonology
AGP
aerosol generating procedure
CDC
Centers for Disease Control and Prevention
CHEST
American College of Chest Physicians
COVID-19
coronavirus disease 2019
GRADE
Grading of Recommendations, Assessment, Development and Evaluations
HCW
health-care worker
PAPR
powered air purifying respirator
PICO
Population, Intervention, Comparator, and Outcome
PPE
personal protective equipment
rRT-PCR
real-time reverse transcription-polymerase chain reaction
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2

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DISCLAIMER: CHEST Guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which should always be sought for any medical condition. The complete disclaimer for this guideline can be accessed at: http://www.chestnet.org/Guidelines-and-Resources.

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