Background Flexible fibreoptic bronchoscopy (FFB) has been used for years as a diagnostic and therapeutic adjunct for the diagnosis of potential airway obstruction as a cause of acute respiratory failure or in the management of hypoxaemia ventilated patients. In these circumstances, it is useful to evaluate airway patency or airway damage and for the management of atelectasis. Objectives To evaluate the use of FFB as a rescue therapy in mechanically ventilated patients with severe hypoxaemic respiratory failure caused by COVID-19. Methods We enrolled 14 patients with severe and laboratory confirmed COVID-19 who were admitted at Mediclinic Midstream Private Hospital intensive care unit in Pretoria, South Africa, in July 2020. Results FFB demonstrated the presence of extensive mucus plugging in 64% (n=9/14) of patients after an average of 7.7 days of mechanical ventilation. Oxygenation improved significantly in these patients following FFB despite profound procedural hypoxaemia. Conclusion Patients with severe COVID-19 pneumonia who have persistent hypoxaemia despite the resolution of inflammatory parameters may respond to FFB with removal of mucus plugs. We propose consideration of an additional pathophysiological acute phenotype of respiratory failure, the mucus type (M-type).
【저자키워드】 COVID-19, Respiratory tract diseases, Ventilated, Therapeutic bronchoscopy, hypoxaemic, Viral; Lung Diseases. Parasitic, Viral; Pneumonia, 【초록키워드】 Severe COVID-19 pneumonia, therapy, Respiratory failure, intensive care, mechanical ventilation, diagnostic, Diagnosis, airway, Laboratory, South Africa, management, therapeutic, Patient, phenotype, hypoxaemia, average, hypoxaemic respiratory failure, ventilated patients, objective, Result, enrolled, evaluate, caused, significantly, demonstrated, respond, FFB, inflammatory parameter, mechanically ventilated patient, Midstream, pathophysiological, plugs, Private, 【제목키워드】 observational study, South Africa, therapeutic, Critical, Midstream, Private, ventilated patient, with COVID-19,