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.