INTRODUCTION
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus
responsible for COVID-19 first appeared in Wuhan, China in December
2019. From there it has rapidly spread to become a global
pandemic.1 The United States now has the highest
number of deaths due to COVID-19.2 The virus is highly
infectious with a median daily reproduction rate of 2.35 in Wuhan,
China.3 The most common presenting symptoms of the
coronavirus are fever, dry cough, and dyspnea. 1Although 80% of cases are of asymptomatic to moderate severity, about
6-10% of cases progress to require the use of ventilatory support.1,4
The virus has placed a significant burden on the healthcare system. Many
hospitals are adapting to the new challenges they face in light of
SARS-CoV-2. A myriad of organizations are creating new guidelines
pertaining to COVID-19 to protect health care workers and decrease the
spread of transmission. The virus is transmitted through fomite
exposure, respiratory droplets, and aerosolization. Certain procedures,
such as bronchoscopy, laryngoscopy and esophagoscopy, result in close
proximity with respiratory droplets and aerosol generation. Thus, the
CDC has deemed bronchoscopy a high-risk procedure. 5
Bronchoscopy is used in a variety of diagnostic and therapeutic manners.
Specifically in intensive care units, bronchoscopy is valuable in
visualizing airways, sampling for diagnostic purposes, and managing
artificial airways.6 In addition to bronchoscopy,
laryngoscopy and esophagoscopy may also be used to visualize the airway
and remove foreign bodies.7,8 Due to the high-risk
nature of the procedure, organizations have issued new guidelines to
establish safer practices.
The primary aim of this study is to perform a literature review and
provide a summary of results of new bronchoscopy guidelines with respect
to COVID-19. The second aim of this study is to provide guidelines using
the expertise and experience of established otolaryngologists.