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With the current COVID pandemic: should we use single-use flexible bronchoscopes instead of conventional bronchoscopes?

We would like to describe the numerous advantages of single-use bronchoscopes over conventional bronchoscopes especially during the COVID pandemic. Recently, Zaidi et al. did a comparative study between single-use and conventional bronchoscopes for bronchoalveolar lavage (BAL) [1]. They concluded that with single-use bronchoscopes, they achieved a larger BAL volume yield than conventional bronchoscopes, with comparable cell yield and viability [1]. Better volume yields may potentially reduce post-procedure side effects such as pleuritic chest pain and cough. With single-use devices, the risk of cross infection is eliminated, providing reassurance to researchers and participants [2]. This single-use flexible bronchoscope can be reusable for the same patient and should be stored in his isolate room [2]. Reduced maintenance requirements can be cost effective [3]. In addition, single-use flexible bronchoscopes have been evaluated in the critical care setting with favorable results for BAL, percutaneous tracheostomy, intubation, and suction [4]. Regarding the important question of cost, a recent study suggests benefits from the use of single-use flexible bronchoscopes in terms of cost effectiveness, cross-contamination, and resource utilization [3]. Single-use flexible bronchoscopes could be very useful in the setting of the current coronavirus pandemic. We have already started using them.

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Abbreviations

BAL:

Bronchoalveolar lavage

ICU:

Intensive care unit

References

  1. 1.

    Zaidi SR, Collins AM, Mitsi E, Reiné J, Davies K, Wright AD, et al. Single use and conventional bronchoscopes for Broncho alveolar lavage (BAL) in research: a comparative study (NCT 02515591). BMC Pulm Med. 2017;17(1):83. https://doi.org/10.1186/s12890-017-0421-7.

  2. 2.

    Kovaleva J, Peters FTM, van der Mei HC, Degener JE. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev. 2013;26:231–54.

  3. 3.

    Mouritsen JM, Ehlers L, Kovaleva J, Ahmad I, El-Boghdadly K. A systematic review and cost effectiveness analysis of reusable vs. single-use flexible bronchoscopes. Anaesthesia. 2020;75(4):529–40. https://doi.org/10.1111/anae.14891 Epub 2019 Nov 8.

  4. 4.

    Mankikian J, Ehrmann S, Guilleminault L, Le Fol T, Barc C, Ferrandiere M, et al. An evaluation of a new single-use flexible bronchoscope with a large suction channel: reliability of bronchoalveolar lavage in ventilated piglets and initial clinical experience. Anaesthesia. 2014;69(7):701–6.

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Acknowledgements

We would like to thank Dr. Melissa Jackson for the critical review of the manuscript.

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PMH, SR, and DDB designed the paper. All authors participated in drafting and reviewing. All authors read and approved the final version of the manuscript.

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Correspondence to Patrick M. Honore.

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Honore, P.M., Mugisha, A., Kugener, L. et al. With the current COVID pandemic: should we use single-use flexible bronchoscopes instead of conventional bronchoscopes?. Crit Care 24, 234 (2020). https://doi.org/10.1186/s13054-020-02965-9

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