MINI-REVIEW


Bronchoscopy Findings of Severe and Critical COVID-19 Patients Treated in ICU: A Year of Experience in a Developing Country



Irandi Putra Pratomo1, 2, 3, *, Gatut Priyonugroho1, 2, 3, Hario Baskoro1, 2, 3, R.R. Diah Handayani1, 2, 3, Jamal Zaini1, 2, 3, Anna Rozaliyani2, 3, 4, Dita Aditianingsih3, 5, Ardiana Kusumaningrum6, Tutug Kinasih2, Ike Maretta7, Himela Asfi Rasigita7
1 Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, 13230, Indonesia
2 Pulmonology and Respiratory Medicine Staff Group, Universitas Indonesia Hospital, Universitas Indonesia, Depok, 16424, Indonesia
3 COVID-19 Task Force, Universitas Indonesia Hospital, Universitas Indonesia, Depok, 16424, Indonesia
4 Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
5 Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, 10430 Indonesia, and Anesthesiology and Intensive Care Medicine Staff Group, Universitas Indonesia Hospital, Universitas Indonesia, Depok, 16424, Indonesia
6 Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, 10430 Indonesia, and Clinical Laboratory Unit, Universitas Indonesia Hospital, Universitas Indonesia, Depok, 16424, Indonesia
7 Nursing Unit, Universitas Indonesia Hospital, Universitas Indonesia, Depok, 16424, Indonesia


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Creative Commons License
© 2022 Pratomo et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia - Persahabatan Hospital, Jl. Persahabatan Raya No.1, Pisangan Timur, Pulogadung, Jakarta, 13230 Indonesia; Tel: +62-21-489-3536; E-mail: irandiputra@ui.ac.id.


Abstract

Background:

Bronchoscopy procedure in patients with COVID-19 poses significant challenges, especially in a developing country with limited resources.

Objectives:

We aim to describe the clinical characteristics of severe and critical COVID-19 patients treated in an intensive care unit (ICU) and their bronchoscopy findings.

Methods:

We performed a retrospective analysis of clinical data of ICU patients with COVID-19 treated and received bronchoscopy procedures. This study retrospectively included all consecutive patients who underwent bronchoscopy at a teaching hospital in Depok, Indonesia, from May, 2020, until May, 2021.

Results:

A total of 57 bronchoscopy procedures in 54 patients were performed in this study. Primary procedure indications were retained mucus (68.4%) and ventilatory support weaning failure (15.8%). Bronchoscopic findings were mostly hyperaemic mucosa (95.00%) and purulent secretion (50.90%). Microbiological findings from bronchoalveolar samples were Acinetobacter baumanii, Klebsiella pneumoniae, and Candida albicans (33.3%, 26.6%, and 10.5%, respectively). The most common fungal isolated were Candida albicans (28%), followed by Candida tropicalis (16%) and Aspergillus sp. (8%). The overall length of hospital stay was 24 days, and the in-ICU stay was 22.06 ± 10.99 days. The patients’ survival of 28-days postprocedural outcome was 25.9% (14 subjects). Follow-up found that 20.4% of patients survived after sixty days of hospitalization.

Conclusion:

Diagnostic and therapeutic bronchoscopy in ICU patients with COVID-19 was safe and feasible to perform in developing countries with limited resources. It could help bronchial mucous clearance and confirm microbiological infection. The procedures should be strictly performed for patients with indications and comply with safety standards.

Keywords : COVID-19 virus disease, Bronchoscopy, Bronchoalveolar lavage, Microbiological infection, Intensive care, Developing country.