RESUMO
BACKGROUND: The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate. PATIENTS AND METHODS: This observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression. RESULTS: A total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR 1.60; p=0.041), absence of mucosal hyperaemia (OR 0.49; p=0.041) and the presence of haematic secretions (OR 1.79; p=0.032). CONCLUSION: Bronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19.
RESUMO
For many years the film industry has been a loyal contributor to the tobacco industry by showing actors smoking cigarettes onscreen and hence encouraging young people to become nicotine addicts. The Prevention of Nicotine Addiction movement in the United States has adequately documented this phenomenon and there is now sufficient scientific evidence to demonstrate the close relationship between smoking in films and the onset of smoking in adolescents and young adults. To encourage social debate, working groups have been created to put pressure on the film industry through the use of commercials in mainstream media in the hope of making Hollywood accept its responsibility and change its attitude. Smoke Free Movies, an initiative led by the University of California, is making substantial progress toward limiting the appearance of cigarettes in American movies. In Europe, and particularly in Spain, these kinds of initiatives are still fairly new. The Prevention of Nicotine Addiction Movement in Spain should learn from the United States in order to promote similar policies. Some of the proven measures include the following: certification in credits stating no payment was received for the appearance of tobacco in the film, projection of anti-tobacco advertisements before any film that contains scenes with smoking, no brand identification and no subsidies for films that encourage smoking.