• Momen M Wahidi, Samira Shojaee, Carla R Lamb, David Ost, Fabien Maldonado, George Eapen, Daniel A Caroff, Michael P Stevens, Daniel R Ouellette, Craig Lilly, Donna D Gardner, Kristen Glisinski, Kelly Pennington, and Raed Alalawi.
• Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, NC. Electronic address: momen.wahidi@duke.edu.
• Chest. 2020 Sep 1; 158 (3): 126812811268-1281.

BackgroundThe coronavirus disease 2019 (COVID-19) has swept the globe and is causing significant morbidity and mortality. Given that the virus is transmitted via droplets, open airway procedures such as bronchoscopy pose a significant risk to health-care workers (HCWs). The goal of this guideline was to examine the current evidence on the role of bronchoscopy during the COVID-19 pandemic and the optimal protection of patients and HCWs.Study Design And MethodsA group of approved panelists developed key clinical questions by using the Population, Intervention, Comparator, and Outcome (PICO) format that addressed specific topics on bronchoscopy related to COVID-19 infection and transmission. MEDLINE (via PubMed) was systematically searched for relevant literature and references were screened for inclusion. Validated evaluation tools were used to assess the quality of studies and to grade the level of evidence to support each recommendation. When evidence did not exist, suggestions were developed based on consensus using the modified Delphi process.ResultsThe systematic review and critical analysis of the literature based on six PICO questions resulted in six statements: one evidence-based graded recommendation and 5 ungraded consensus-based statements.InterpretationThe evidence on the role of bronchoscopy during the COVID-19 pandemic is sparse. To maximize protection of patients and HCWs, bronchoscopy should be used sparingly in the evaluation and management of patients with suspected or confirmed COVID-19 infections. In an area where community transmission of COVID-19 infection is present, bronchoscopy should be deferred for nonurgent indications, and if necessary to perform, HCWs should wear personal protective equipment while performing the procedure even on asymptomatic patients.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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