Bronchoscopy Applications

Limiting Aerosolization in Pediatric Bronchoscopy

AABIP recommends physicians use disposable, or single-use, bronchoscopes if bronchoscopy is warranted during the current crisis, which has killed more than 80,000 patients in the U.S.

Using disposable, translucent drapes to create a tent around a patient is one way to limit the threat of disease transmission from aerosolization during pediatric microlaryngoscopy and bronchoscopy.

That’s according to input from pediatric otolaryngologists, anesthesiologists, occupational medicine specialists, nursing staff, and medical engineers in a new research paper. The input is significant because of the risks to healthcare workers on the frontlines of the battle against COVID-19.

Bronchoscopy is an aerosol-generating procedure, and the novel coronavirus is spread through droplets produced when an infected person coughs or sneezes.

The paper, “Pediatric laryngoscopy and bronchoscopy during the COVID-19 pandemic: A four-center collaborative protocol to improve safety with perioperative management strategies and creation of a surgical tent with disposable drapes,” outlines several other safety measures that may be of use when the current COVID-19 crisis wanes. The International Journal of Pediatric Otorhinolaryngology published the paper in April 2020.

Creating a surgical tent using disposable drapes is a relatively simple technique to protect operating room personnel, according to the authors.

“The few additional resources that are required are generally accessible in any operating room or institution," they write. "This technique may prevent aerosolization of other pathogens in the future.”

To create the disposable drape tent, healthcare workers should:

  • Rotate the bed so the surgeon is standing at the head
  • Cover the patient’s eyes with water-tight adhesive coverings to allow for adequate washing of patient face after the procedure
  • Secure an ultrafiltration smoke evacuator to the patient’s chest, facing the patient’s head to filter viral particles during the procedure (this does not replace need for normal surgical suction)
  • Place an ether screen over the patient at chest level and secure to an OR table
  • Place clear, impermeable surgical drape over the patient’s head and body, suspended by ether screens (the bronchoscopy table should be under the same drape)

The authors do not recommend fully covering the patient in a drape. The drape, after all, needs to be easily removed and disposed of after the procedure. Aerosol particles should be contained within the drape at disposal.

Typically, about 500,000 bronchoscopies are performed in the U.S. annually. The American Association for Bronchology and Interventional Pulmonology (AABIP), however, has advised against bronchoscopy on suspected or confirmed COVID-19 patients. AABIP, in its March advisory, suggested other diagnostic measures such as nasopharyngeal and oropharyngeal swabs for collecting upper respiratory samples. For intubated patients, tracheal aspirates and non-bronchoscopic alveolar lavage may also be used.

AABIP recommends physicians use disposable, or single-use, bronchoscopes if bronchoscopy is warranted during the current crisis, which has killed more than 80,000 patients in the U.S.

The first cases of COVID-19 transmission to healthcare providers were reported as early as January.

Pulmonologists will be concerned about the risks of infection transmission from aerosolization during bronchoscopy long after the current COVID-19 pandemic. And some COVID-19-related precautions and adaptations may prove to be useful when bronchoscopy becomes a routine diagnostic and therapeutic procedure once again.

Patients should also be tested prior to a procedure, according to the paper. But testing cannot be a fail-safe, the authors write.

“Currently, there is variability across institutions with respect to access to testing, duration of testing, and reliability of results including false negative rates that at some institutions may be as high as 30–40 percent,” according to the paper.

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