Pediatric rigid bronchoscopy and foreign body removal during the COVID-19 pandemic: case report
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CASE REPORT
Open Access
Pediatric rigid bronchoscopy and foreign body removal during the COVID-19 pandemic: case report Darren Jonathan Leitao*
and Jodi L. P. Jones
Abstract We present the case of an eight year old boy who presented with foreign body aspiration during the COVID-19 pandemic. The patient was taken the operating room for rigid bronchoscopy and foreign body removal. The details of the operation, steps taken for protection of health care workers, and lessons learned are discussed. Bronchoscopy was performed using N95 respirators and Stryker Flyte Hood garments, combined with a streamlined instrument set-up. Simulation in advance of these cases improves communication and operative planning. Surgeons should have equipment to retrieve foreign bodies from the oropharynx available. Techniques that reduce surgical time and thus exposure risk should be considered. Keywords: COVID-19, SARS-CoV-2, Bronchoscopy, Foreign body aspiration”, “Case report”
Background Foreign body aspiration is a potentially critical airway emergency in children. Our current state of the art is endoscopic foreign body retrieval using rigid bronchoscopes and optical forceps for optimal imaging and surgical removal. These techniques are performed in children that are spontaneously ventilating under general anesthetic, exposing the surgical team to patient generated aerosols. The 2019 novel coronavirus disease (COVID-19) pandemic has dramatically changed our comfort with these procedures. Aerosol-generating medical procedures (AGMPs) pose significant risks of transmission of the sars-coV-2 virus to healthcare workers (HCWs) [1]. There is significant concern among otolaryngologists regarding their risk of occupational exposure during AGMP’s [2], especially since the first physician death from COVID-19 globally was an otolaryngologist in Wuhan, China [3]. * Correspondence: [email protected] Department of Otolaryngology-Head and Neck Surgery, Rady College of Medicine, University of Manitoba, Room GB421-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
Bronchoscopy with foreign body removal is an AGMP that must often occur in emergent, life-threatening situations, precluding our ability to obtain pre-operative confirmation of negative COVID-19 status. The use of administrative and environmental protocols and personal protective equipment (PPE) by all operating room staff are therefore critical to ensuring the safety of HCW’s in this operating room setting. Several protocols for pediatric airway management have been developed worldwide, as well as unique modifications to standard practice, to reduce exposure to aerosols intra-operatively [4, 5]. These protocols have introduced and incorporated unique surgical draping over the patient to trap aerosols during bronchoscopy, minimized equipment and personnel in operating environments, and outlined the PPE requirements for staff. This paper will highlight our experience of a case of bronchoscopy for foreign body removal under emergent conditions, and our operating room processes developed to
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