A new device for bronchoscopy for better protection.

BACKGROUND: During the COVID-19 pandemic, the risk of transmission of SARS-CoV-2 has not been precisely known in bronchoscopy procedures. We have designed a cabinet device called Ankara University Bronchoscopy Cabinet (Aubrocab®) to protect healthcare. We aimed to evaluate preventing effect of Aubrocab® on aerosol spreading by measuring the particles in the bronchoscopy suite. METHODS: The patients were categorized into two groups as those who underwent bronchoscopy with and without Aubrocab®. We measured PM 0.5 levels before and after bronchoscopy in the bronchoscopy suite. RESULTS: A total of 82 patients, 62 of whom underwent bronchoscopy with Aubrocab®, were enrolled in the study. The PM 0.5 level measured before bronchoscopy was similar in both groups, whereas the PM 0.5 level measured after bronchoscopy was lower in the Aubrocab® group (42,603 ± 8,632 vs. 50,377 ± 10,487, p = 0.001). The percent of particle change (50.76 ± 19.91 vs 67.15 ± 24.24, p = 0.003) and the difference of the particle numbers between pre and postprocedure (13,638 ± 4,292 and 19,501 ± 5,891, p < 0.001) were lower in the Aubrocab® group. DISCUSSION: Our institution developed a barrier device named Aubrocab® which was shown to prevent excessive aerosol release in addition to routine precautions during bronchoscopy procedures.

Successful treatment of COVID-19 infection in a patient with tracheostomy.

Coronavirus disease 2019 (COVID-19) has been demonstrated to be the cause of emerging atypical pneumonia. In patients with tracheostomy, coronavirus hypothetically coexists with well-known bacterial agents. A 61-year-old male patient with tracheostomy was admitted to the hospital with dyspnea, fever and increased tracheal secretions. Laboratory findings revealed lymphopenia and elevated C-reactive protein and procalcitonin levels. Chest computed tomography showed consolidation areas and ground-glass opacities more prominent in subpleural areas. Although; two consecutive RT-PCR analyses of combined nasopharengeal/oropharengeal swabs were found to be negative for SARS-CoV-2 RNA, positivity was reported for endotracheal aspirate (ETA) sample. Significant growth of Pseudomonas aeruginosa and Stenotrophomonas maltophilia was detected in the bacterial culture of ETA sample. In conclusion, clinical samples for SARS-CoV-2 should be obtained through the lower respiratory tract, if possible and if upper airway samples are negative. To the best our knowledge, our paper is the first report of the patient with tracheostomy who was treated successfully for COVID-19.

Prone positioning in non-intubated patients with COVID-19.

Prone positioning is a well-known supportive maneuver to improve oxygenation for patients with moderate to severe acute respiratory distress syndrome (ARDS). Although this technique is usually performed to sedated patients on invasive mechanical ventilation, it has been used in non-intubated patients frequently during the coronavirus diseases-2019 (COVID-19) pandemic. Favorable outcomes have been reported mainly in combining the prone positioning with high flow nasal cannula (HFNC) or non-invasive ventilation (NIV). Due to limited data, a standard approach for the awake prone positioning has not yet been defined. In this manuscript, we reviewed the literature data about prone positioning in non-intubated patients with COVID-19. According to available literature data, we concluded that prone positioning in non-intubated COVID-19 patients may improve oxygenation and prevent the need for invasive mechanical ventilation. But the efficacy is still controversial in the early stage of the disease due to pulmonary mechanics. Further studies are needed to the defined optimal approach of awake prone positioning in COVID-19 patients with hypoxemic respiratory failure.

High flow nasal cannula in COVID-19: a literature review.

In recent years, high flow nasal cannula (HFNC) is a respiratory support system that has become prominent in the treatment of respiratory failure. HFNC provides higher concentration and flow of oxygen, resulting in decreasing anatomic dead space by preventing rebreathing and ensure positive end-expiratory. However, in COVID-19, the usage of HFNC is much controversial due to concerns about the benefits and risk of aerosol-dispersion. Considering the debates about the use of HFNC, we reviewed the literature related to the usage of HFNC in COVID-19. The available reports suggest that HFNC provides high concentrations of oxygen to the patients, who can not reach with conventional devices. HFNC can reduce the requiring of intubation in patients with COVID-19, and it can decrease the length of intensive care unit stay, and complications related to mechanical ventilation. Also HFNC can in achieving apneic oxygenation in patients during airway management. Besides that, the use of high-flow oxygen cannulas can produce aerosols. So, HFNC treatment should be carried out in a negative pressure room; when it is not possible, devices should be undertaken in a single room.