Bronchoscopy complications.
BAL is reported to be safe, a transient drop in oxygen saturation is
occasionally reported in the more severe patients. No major adverse
events were reported to date and no deaths were recorded. The most
frequent adverse events, described in a minority of patients, were
transient hypoxaemia and fever. Mondoni et al reported complications
related to bronchoscopy in 5/109 (4.5%) patients. Fever was recorded
after BAL in 2/109 (1.8%). 3/109 (2.7%) patients with a known mild
respiratory failure had a transient worsening of their gas exchange
after bronchoscopy performed during oxygen supplementation. When
bronchoscopy was performed in patients who required non-invasive
mechanical ventilation (NIV), severe hypoxia and subsequent intubation
has been reported in 6 patients.18
BAL in COVID-19 is reported as a safe and feasible procedure in all
studies, with a safety profile that is similar to what previously
reported in non-COVID-19 patients. The risk-benefit profile should be
carefully evaluated in severe patients in NIV, because of the possible
risk of hypoxemia leading to intubation. The small numbers and the wide
heterogeneity of studies prevent us from drawing any firm conclusion on
possible differences in terms of safety and diagnostic accuracy between
BAL and other sampling techniques, such as mini-BAL and bronchial
washes. Future prospective trials are needed to address the safety and
accuracy of these methods.