The use of pediatric flexible bronchoscopy in the COVID-19 pandemic era

Abstract

On March 11, 2020, the World Health Organization (WHO) declared the pandemic because of a novel coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In January 2020, the first transmission to healthcare workers (HCWs) was described. SARS-CoV-2 is transmitted between people because of contact, droplets, and airborne. Airborne transmission is caused by aerosols that remain infectious when suspended in air over long distances and time. In the clinical setting, airborne transmission may occur during aerosol generating procedures like flexible bronchoscopy. To date, although the role of children in the transmission of SARS-CoV-2 is not clear the execution of bronchoscopy is associated with a considerably increased risk of SARS-CoV-2 transmission to HCWs. The aim of this overview is to summarize available recommendations and to apply them to pediatric bronchoscopy. We performed systematic literature searches using the MEDLINE (accessed via PubMed) and Scopus databases. We reviewed major recommendations and position statements published at the moment by the American Association for Bronchology and Interventional Pulmonology, WHO, European Center for Disease Prevention and Control and expert groups on the management of patients with COVID-19 to limit transmission among HCWs. To date there is a lack of recommendations for safe bronchoscopy during the pandemic period. The main indications concern adults and little has been said about children. We have summarized available recommendations and we have applied them to pediatric bronchoscopy.

Keywords: COVID-19; SARS-CoV-2; children; flexible Bronchoscopy; healthcare workers.

Figure 1

Flow chart for bronchoscopy during the COVID‐19 pandemic

Figure 2

Prevention of patient's aerosol transmission during bronchoscopy, with surgery mask (A) and suction (B). Illustrations by D.P. La Regina

Figure 3

Noninvasive ventilation mask with bronchoscope insertion channel. Illustrations by D.P. La Regina

Figure 4

Bronchoscope inserted through a suction port of a three‐way connector of a noninvasive ventilation mask (A), and bronchoscope inserted through a suction port of a three‐way connector of an extension tube (B). Illustrations by D.P. La Regina