• Bronchoalveolar lavage fluid (BALF)
• Diagnostic value
• Pulmonary infection
• Targeted next-generation sequencing
• Traditional microbial culture

• Humans
• High-Throughput Nucleotide Sequencing/methods
• Bacteria/genetics
• Bacteria/isolation & purification
• Bacteria/classification
• Respiratory Tract Infections/microbiology
• Respiratory Tract Infections/diagnosis
• Fungi/genetics
• Fungi/isolation & purification
• Fungi/classification
• Male
• Female
• Middle Aged
• Sensitivity and Specificity
• Adult
• Aged
• Viruses/genetics
• Viruses/isolation & purification
• Viruses/classification
• Microbial Sensitivity Tests
• Molecular Diagnostic Techniques/methods
• Microbiological Techniques/methods

• bronchoscopy
• coronavirus disease of 2019
• flexible bronchoscopy
• pediatrics
• severe acute respiratory syndrome coronavirus 2

• Humans
• Bronchoscopy/methods
• Male
• Retrospective Studies
• Female
• Child
• COVID-19/transmission
• COVID-19/prevention & control
• COVID-19/diagnosis
• COVID-19/epidemiology
• Child, Preschool
• Infant
• Adolescent
• SARS-CoV-2
• Personal Protective Equipment
• Foreign Bodies
• Respiratory Sounds
• Pandemics

• None

• bronchoscopy
• intensive care
• pneumonia
• respiratory infections

• MR/V006118/1 UK Research and Innovation
• 222919/Z/21/Z Wellcome Trust

• Humans
• Bronchoscopes
• Cost-Benefit Analysis
• Biopsy
• Environment

• COVID-19
• bronchoalveolar lavage
• infections
• interstitial pneumonia
• interventional pulmonology

• Pulmonary airway segmentation
• Topological prior knowledge
• Traditional and deep-learning methods

• Humans
• Trees
• Tomography, X-Ray Computed/methods
• Image Processing, Computer-Assisted/methods
• Algorithms
• Lung/diagnostic imaging
• Lung Diseases

• MR/V023799/1 Medical Research Council

• admission
• bronchoscopy
• covid-19
• outpatient

• Humans
• Bronchoscopy
• Tertiary Care Centers
• COVID-19/epidemiology
• Pandemics
• Retrospective Studies

• Humans
• Bronchoscopy
• COVID-19
• Portugal/epidemiology
• Pulmonary Medicine
• Societies
• Practice Guidelines as Topic

• Humans
• Bronchoscopy
• Aerosols

• Swine
• Animals
• Bronchoscopy/methods
• Biomechanical Phenomena
• Robotic Surgical Procedures
• Phantoms, Imaging
• Endoscopy

• COVID-19
• bronchoscopy and interventional techniques
• coronavirus disease
• e-mask

The added role of bronchoalveolar lavage (BAL) in SARS-CoV-2 detection in hospitalized patients with suspected COVID-19 pneumonia and at least one negative nasopharyngeal swab (NPS) has yet to be definitively established. We aimed to provide a systematic review and meta-analysis to summarize data from the literature on the diagnostic yield of BAL in this context. We searched Medline and Embase for all studies reporting outcomes of interest published up to October 2021. Two authors reviewed all titles/abstracts and retrieved the selected full texts according to predefined selection criteria. The summary estimate was derived using the random-effects model. Thirteen original studies, involving 868 patients, were included. The summary estimate of proportions of SARS-CoV-2 positivity in BAL fluid in patients with at least one previous negative NPS was 20% (95% confidence interval [CI]; 11–30%). Moreover, microbiological tests of BAL fluid led to the identification of other pathogens, mainly bacteria, in up to two-thirds of cases. BAL plays a crucial role in the diagnostic work-up of patients with clinical suspicion of COVID-19 and previous negative NPS, as it allowed to detect the infection in a significant proportion of subjects, who would have been otherwise misclassified, with relevant implications in the prevention of disease spread, especially in hospital settings.

• COVID-19
• airborne particle
• bronchoscopy
• coronavirus disease
• e-mask
• prevention
• respiratory protective devices

• Bronchoscopy/adverse effects
• Bronchoscopy/methods
• Carbon Dioxide
• Endoscopy
• Humans
• Masks/adverse effects
• Oxygen
• Respiratory Rate

• Bronchoscopy/methods
• COVID-19
• Coinfection
• Critical Illness
• Humans
• Intensive Care Units

• Tumor
• development
• device
• endotracheal intubation

• COVID-19
• COVID-19 Vaccines/administration & dosage
• Consensus
• Delphi Technique
• Health Personnel/standards
• Humans
• Infection Control/standards
• Infectious Disease Transmission, Patient-to-Professional/prevention & control
• Intensive Care Units/standards
• Personal Protective Equipment/standards
• SARS-CoV-2/isolation & purification

• Bronchoscopy
• COVID-19
• Protocol
• Risk
• SARS-CoV-2
• Transmission

• COVID-19
• SARS-CoV-2
• bronchoscopy
• complications
• indications

• Bronchoscopy
• COVID-19
• Female
• Humans
• Male
• Prospective Studies
• Retrospective Studies
• SARS-CoV-2

Differentiating COVID-19 from other causes of viral pneumonia, like herpes simplex (HSV), can be complicated by shared clinical and laboratory features. Viral pneumonia is mostly diagnosed based on molecular or serological techniques. Serological immunoassay interferences, often attributed to concurrent appearance of heterologous (viral) immunoglobulins, is well-known, but has not been studied in COVID-19 patients. Following false positive HSV immunoglobulin M (IgM) results in our index patient, 25 other COVID-19 patients were tested for HSV-1/2 IgM with the chemiluminescent Liaison assay and Euroimmun enzyme-linked immunosorbent assay. Forty-five percent of COVID-19 patients tested positive for HSV IgM with Liaison. No HSV indices were positive with Euroimmun enzyme-linked immunosorbent assay, suggesting immunoassay interference. Significant correlation between HSV IgM and SARS-CoV-2 IgM/IgG positivity was found. Adding 0.5% polyvinylpyrrolidone, inhibiting non-specific solid-phase adsorption, abolished interference in 22% of false positive cases, suggesting interference caused by solid-phase reactive IgM. Hence, serologic immunoassay results should be interpreted with caution in COVID-19 patients.

• bronchoscopy
• bronchoalveolar lavage
• covid-19
• coronavirus infections
• sars-cov-2
• betacoronavirus
• intubation
• intratracheal
• respiration
• artificial

• Adult
• Aged
• Brazil/epidemiology
• Bronchoscopy/adverse effects
• COVID-19/epidemiology
• Disease Outbreaks
• Female
• Hospitals, University
• Humans
• Inpatients
• Male
• Middle Aged
• Retrospective Studies

Flexible bronchoscopy (FB) has become a standard of care for the triad of inspection, sampling, and treatment in critical care patients. It is an invaluable tool for diagnostic and therapeutic purposes in critically ill patients in intensive care unit (ICU). Less is known about its role outside the ICU, particularly in the intermediate care unit (IMCU), a specialized environment, where an intermediate grade of intensive care and monitoring between standard care unit and ICU is provided. In the IMCU, the leading indications for a diagnostic work-up are: To visualize airway system/obstructions, perform investigations to detect respiratory infections, and identify potential sources of hemoptysis. The main procedures for therapeutic purposes are secretion aspiration, mucus plug removal to solve atelectasis (total or lobar), and blood aspiration during hemoptysis. The decision to perform FB might depend on the balance between potential benefits and risks due to frailty of critically ill patients. Serious adverse events related to FB are relatively uncommon, but they may be due to lack of expertise or appropriate precautions. Finally, nowadays, during dramatic recent coronavirus disease 2019 (COVID-19) pandemic, the exact role of FB in COVID-19 patients admitted to IMCU has yet to be clearly defined. Hence, we provide a concise review on the role of FB in an IMCU setting, focusing on its indications, technical aspects and complications.

• Flexible bronchoscopy
• Critically ill
• Bronchoalveolar lavage
• Indication
• Complication
• COVID-19

Coronavirus disease-2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a new disease characterized by secondary Aspergillus mold infection in patients with COVID-19. It primarily affects patients with COVID-19 in critical state with acute respiratory distress syndrome, requiring intensive care and mechanical ventilation. CAPA has a higher mortality rate than COVID-19, posing a serious threat to affected individuals. COVID-19 is a potential risk factor for CAPA and has already claimed a massive death toll worldwide since its outbreak in December 2019. Its second wave is currently progressing towards a peak, while the third wave of this devastating pandemic is expected to follow. Therefore, an early and accurate diagnosis of CAPA is of utmost importance for effective clinical management of this highly fatal disease. However, there are no uniform criteria for diagnosing CAPA in an intensive care setting. Therefore, based on a review of existing information and our own experience, we have proposed new criteria in the form of practice guidelines for diagnosing CAPA, focusing on the points relevant for intensivists and pulmonary and critical care physicians. The main highlights of these guidelines include the role of CAPA-appropriate test specimens, clinical risk factors, computed tomography of the thorax, and non-culture-based indirect and direct mycological evidence for diagnosing CAPA in the intensive care unit. These guidelines classify the diagnosis of CAPA into suspected, possible, and probable categories to facilitate clinical decision-making. We hope that these practice guidelines will adequately address the diagnostic challenges of CAPA, providing an easy-to-use and practical algorithm to clinicians for rapid diagnosis and clinical management of the disease.

• COVID-19-associated pulmonary aspergillosis
• clinical risk factors
• computed tomography
• diagnosis
• intensive care
• non-culture-based mycological factors
• practice guidelines

• COVID-19
• bronchoscopy
• diagnostic strategies

COVID-19 quickly became a pandemic causing millions of infections and mortalities. It required real-time adjustments to healthcare systems and infection prevention and control (IPC) measures to limit the spread and protect healthcare providers and hospitalized patients. IPC guidelines were adopted and developed based on experience gained during the MERS-CoV and SARS-CoV outbreaks. The aim of this narrative review is to summarize current evidence on IPC in healthcare settings and patients with COVID-19 to prevent nosocomial infections during the actual pandemic. A search was run on PubMed using the terms (‘COVID-19’ [Mesh]) AND (‘Infection Control’ [Mesh]) between 2019 and 2021. We identified 86 studies that were in accordance with our aim and summarized them under certain themes as they related to COVID-19 infection control measures. All the guidelines recommend early diagnosis and rapid isolation of COVID-19 patients. The necessary precautions should be taken comprising the whole process, starting with an infectious disease plan, administrative and engineering controls, triage, and PPE training. Guidelines should target modes of transmission, droplet, aerosol, and oral–fecal, while recommending control precautions. Healthcare facilities must promptly implement a multidisciplinary defense system to combat the outbreak.

• COVID-19
• healthcare-associated infection
• infection control

Bronchoscopy is a safe and commonly performed procedure for diagnostic as well as therapeutic indications. Bronchoscopy is also an aerosol-generating procedure, and due to the risk of severe acute respiratory syndrome coronavirus 2 transmission during the procedure, routine bronchoscopy has been discouraged by multiple professional societies, despite any solid evidence. There are only a few reports of bronchoscopy in patients with coronavirus disease 2019 in the literature. Bronchoscopy in this patient population plays a crucial role not only in the diagnosis of coronavirus disease 2019 but also in the identification of secondary bacterial or fungal infections and in directing appropriate antimicrobial therapy. Bronchoscopy with therapeutic interventions may be lifesaving. Based on the literature, the risk of coronavirus disease 2019 transmission appears to be low among bronchoscopists and other healthcare workers when appropriate personal protective equipment is used. Bronchoscopy in patients with coronavirus disease 2019 should be strongly considered when clinically indicated.

• bronchoscopy
• coronavirus disease 2019
• diagnosis
• intensive care unit
• lung cancer
• severe acute respiratory syndrome coronavirus 2

• Bronchoscope
• Endoscope
• Nosocomial infections
• Reprocessing

• Sociedad Española de Neumología y Cirugía Torácica

• Bronchoscopy
• Droplet precaution

In this study, we aimed to evaluate the attitudes and behaviors of physicians performing bronchoscopy during the COVID-19 outbreak.

Between March 2020 and May 2020, a total of 153 physicians were included in the study. An invitation letter for the participation in the study with a structured questionnaire of 18 questions were sent to the mail groups twice with five-day intervals. Participation in the study was allowed, until the third day after the second mail was sent.

All participants completed the questionnaire. According to the results, 33% of the physicians did not perform bronchoscopy and the majority of the physicians performed very few procedures during the outbreak, although the participants mostly worked at the tertiary hospitals (mean: 7.2±9.3). A total of 20% of the physicians performed bronchoscopy in potential or proven COVID-19 patients. Almost all of the physicians who participated in the survey reported the use of personal protective equipment such as masks and goggles during the procedure. During the pandemic, 9.7% of the physicians who performed bronchoscopy to potential or proven COVID-19 patients and 4.1% of the participants who did not perform bronchoscopy to any potential or proven COVID-19 patients were found to be infected with the virus (p>0.05).

Physicians who perform bronchoscopy during pandemic act in accordance with the recommendations of guidelines. Although there was no statistically significant difference between the SARS-CoV-2 transmission rates of the teams who performed and did not perform bronchoscopy in potential or proven COVID-19 patients in our study, the high rate of personal protective equipment utilization might have played a role in this result.

• Bronchoscopy
• COVID-19
• SARS-CoV-2
• endobronchial ultrasound
• outbreak

• COVID-19
• SARS-CoV-2
• angiotensin converting enzyme receptor
• smoking

• Aged
• Aged, 80 and over
• Angiotensin-Converting Enzyme 2/genetics
• Angiotensin-Converting Enzyme 2/metabolism
• Bayes Theorem
• COVID-19/pathology
• COVID-19/virology
• Female
• Humans
• Lung/metabolism
• Lung/pathology
• Male
• Real-Time Polymerase Chain Reaction
• Retrospective Studies
• Risk Factors
• SARS-CoV-2/isolation & purification
• Smokers

• 2020A08 University of Padova/Intesa San Paolo Vita bank

• OLV devices
• dexmedetomidine
• enhanced recovery after thoracic surgery
• prehabilitation
• protective one-lung ventilation
• thoracic surgery and COVID-19
• truncal regional blocks

• COVID-19
• bronchoalveolar lavage
• bronchoscopy
• endobronchial ultrasound/transbronchial needle aspiration
• interventional pulmonology
• pandemic

Purpose: The hypothesis of the study was that a multidisciplinary approach involving experienced specialists in diffuse parenchymal lung disease might improve the diagnosis of patients with COVID-19 pneumonia.

Methods: Two pulmonologists, two radiologists, and two pathologists reviewed 27 patients affected by severe COVID-19 pneumonia as the main diagnosis made by non-pulmonologists. To evaluate whether the contribution of specialists, individually and/or in combination, might modify the original diagnosis, a three-step virtual process was planned. The whole lung examination was considered the gold standard for the final diagnosis. The probability of a correct diagnosis was calculated using a model based on generalized estimating equations. The effectiveness of a multidisciplinary diagnosis was obtained by comparing diagnoses made by experienced pulmonologists with those made by non-pulmonologists.

Results: In 19% of cases, the diagnosis of COVID-19-related death was mainly incorrect. The probability of a correct diagnosis increased strikingly from an undedicated clinician to an expert specialist. Every single specialist made significantly more correct diagnoses than any non-pulmonologist. The highest level of accuracy was achieved by the combination of 3 expert specialists (p = 0.0003).

Conclusion: The dynamic interaction between expert specialists may significantly improve the diagnostic confidence and management of patients with COVID-19 pneumonia.

• COVID-19
• COVID-19 pneumonia
• SARS-CoV-2
• diagnostic yield
• multidisciplinary approach

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.

• COVID-19
• SARS-CoV-2
• Thoracoscopy
• bronchoscopy
• interventional pulmonology

• biomarker
• fibrosis
• procollagen type I N-propeptide
• tracheobronchial tuberculosis
• transforming growth factor-β1

The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.

• fiberoptic tracheal tubes
• flexible fiberoptic intubation
• hybrid device
• optical intubation
• optical stylet
• supraglottic airway