INTRODUCTION
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19 first appeared in Wuhan, China in December 2019. From there it has rapidly spread to become a global pandemic.1 The United States now has the highest number of deaths due to COVID-19.2 The virus is highly infectious with a median daily reproduction rate of 2.35 in Wuhan, China.3 The most common presenting symptoms of the coronavirus are fever, dry cough, and dyspnea. 1Although 80% of cases are of asymptomatic to moderate severity, about 6-10% of cases progress to require the use of ventilatory support.1,4
The virus has placed a significant burden on the healthcare system. Many hospitals are adapting to the new challenges they face in light of SARS-CoV-2. A myriad of organizations are creating new guidelines pertaining to COVID-19 to protect health care workers and decrease the spread of transmission. The virus is transmitted through fomite exposure, respiratory droplets, and aerosolization. Certain procedures, such as bronchoscopy, laryngoscopy and esophagoscopy, result in close proximity with respiratory droplets and aerosol generation. Thus, the CDC has deemed bronchoscopy a high-risk procedure. 5
Bronchoscopy is used in a variety of diagnostic and therapeutic manners. Specifically in intensive care units, bronchoscopy is valuable in visualizing airways, sampling for diagnostic purposes, and managing artificial airways.6 In addition to bronchoscopy, laryngoscopy and esophagoscopy may also be used to visualize the airway and remove foreign bodies.7,8 Due to the high-risk nature of the procedure, organizations have issued new guidelines to establish safer practices.
The primary aim of this study is to perform a literature review and provide a summary of results of new bronchoscopy guidelines with respect to COVID-19. The second aim of this study is to provide guidelines using the expertise and experience of established otolaryngologists.