Bronchoscopy and tracheostomy in COVID-19 patients

The COVID-19 pandemic led to an unprecedented surge in critically ill patients, 5 to 20% of whom required invasive mechanical ventilation. Mortality in this group was substantial, and survivors often faced prolonged hospital stays. In this context, bronchoscopy became an invaluable tool for both the diagnosis and management of severe complications in the Intensive Care Unit. Bronchoalveolar lavage demonstrated greater diagnostic sensitivity than nasopharyngeal swabs. However, as an aerosol-generating procedure, bronchoscopy was strictly classified as either urgent or elective, with an emphasis on protecting healthcare personnel, preventing cross-transmission, and optimizing resource utilization. Tracheostomy was subject of considerable debate regarding its timing. During the pandemic, it was recommended to delay the procedure for 14 to 21 days to allow viral load and the risk of transmission to decrease. The procedure played a strategic role in facilitating ventilator weaning, reducing the need for deep sedation, and improving critical care bed turnover. Safety was reinforced through protocols that included planned periods of apnea during key surgical steps and close coordination between the anesthesia and surgical teams. The health crisis reshaped respiratory management, underscoring the importance of a multidisciplinary approach focused on protecting both patients and healthcare professionals.