Interventional pulmonology during COVID-19 pandemic: current evidence and future perspectives

Abstract

COVID-19, caused by SARS-CoV-2 infection, has become increasingly prevalent worldwide, reaching a pandemic stage in March 2020. The organization of health care services had to change because of this new disease, with the need to reallocate staff and materials, besides changing management protocols. A very important challenge is not to expose patients and health care workers to the risk of infection and not to waste personal protective equipment (PPE). In the field of interventional pulmonology, various aspects related to COVID-19 must be taken into great consideration. Although bronchoscopy is not a first-line test for patients with suspected SARS-CoV-2 infection, it has a role in selected cases and it can be useful for differential diagnosis. However, bronchoscopy is an aerosol-generating procedure, that's why its unjustified use could contribute to propagate the virus. For this reason, the utility of each procedure must be carefully evaluated, the patient has to be properly investigated before the procedure, which has to be performed with specific precautions, including adequate PPE. In this review, we summarize the knowledge and the principal statements about endoscopic activity in COVID-19 period, in both diagnosis of COVID-19 and management of patients. How to safely perform both bronchoscopic and pleural-related procedures (thoracoscopy, pleural biopsy and drainage of pleural effusions) is described with the aim to help the staff to decide when and how performing a procedure. We also highlight how interventional pulmonology could help in matter of complications related to COVID-19.

Keywords: COVID-19; SARS-CoV-2; Thoracoscopy; bronchoscopy; interventional pulmonology.

Figure 1

Proposal of flow-chart about the role of bronchoscopy in COVID-19 era.

Figure 2

In order to protect the healthcare workers and the environment, the bronchoscope can be passed through a small hole made on a mask worn by the patient.

Figure 3

An interventional pulmonologist performs a rigid bronchoscopy correctly wearing PPE: gown, FFP3 mask, eye shield and gloves. PPE, personal protective equipment.