Therapeutic consequences of a diagnostic broncho-alveolar lavage in patients in the Intensive Care Unit due to COVID-19: a retrospective cohort study

When patients with coronavirus disease 2019 (COVID-19) on the Intensive Care Unit (ICU) were not improving or clinically deteriorated, bronchoscopy with broncho-alveolar lavage (BAL) was performed to rule out potentially treatable bacterial, viral and fungal superinfections. The purpose of this study was to investigate the therapeutic consequences of a diagnostic BAL in ICU patients with COVID-19. We performed a retrospective analysis in a cohort of patients with COVID-19 on the ICU of the St. Antonius Hospital Nieuwegein in the Netherlands. We compared the administration of antibiotics, antifungal therapy and prednisolone on the day of the BAL and three days later. We hypothesized that a diagnostic BAL did not result in significant changes in therapeutic management. In 73 ICU-patients with COVID-19 who underwent a BAL, the results led to changes in medication prescription in 62% ( p < 0.01) of patients. In these patients, the antibiotic management changed in 36% ( p < 0.01), the antifungal management in 21% ( p < 0.01) and the prednisolone management in 34% ( p < 0.01) of the patients. In ICU-patients who did not improve and therefore underwent a BAL, there was a significant change in antibiotics, antifungal or prednisolone prescriptions in 62% of the patients.