Tracheostomy Followed by Bronchoscopy in A Patient with COVID-19 Lung Disease: Our Experience
Int J Otolaryngol Head Neck Surg
Background: Although the imaging features of coronavirus disease 2019 (COVID-19) are starting to be well determined, what actually occurs within the bronchi is poorly known. Here, we report the processes and findings of bronchoscopy in a patient with COVID-19 accompanied by respiratory failure. Case Summary: A 50-year-old female patient was admitted to a tertiary care hospital in South India on February 3, 2021 for fever and shortness of breath for 4 days that worsened for the last 2 days. The severe acute respiratory syndrome coronavirus 2 nucleic acid test was positive in throat swabs by RTPCR. Routine blood examination showed leucocytosis, with raised markers of inflammation and d-dimer. Oxygen saturation was 80% at baseline and turned to 95% with mechanical ventilation. The patient underwent elective tracheostomy followed by flexible bronchoscopy. There were no abnormalities detected in the tracheal lumen till the level of carina and the tracheal cartilage rings were clear. The mucosa was hyperemic with dry granulations and thick white tenacious secretions. The trachea and bilateral bronchi were patent. There was no neoplasm or ulcerations noted. The patient’s condition did not improve after treatment and she succumbed to the disease. Conclusion: Bronchoscopy can be done under mechanical ventilation with use of proper personal protective equipment (PPE) in patients with COVID-19 lung disease. Considering the high viral load and risks of transmission of the disease to healthcare workers, it is not necessary to perform routine bronchoscopies in all patients with COVID-19 lung diseaseand can be performed on moderate or severe patients who does not improve on routine treatment. In our case, we found hyperemic mucosa with dry granulations and tenacious white secretions limited to the carina and primary bronchus on bronchoscopy.