Role of narrow band imaging in assessing bronchial mucosal hypervascularization in COVID-19 patients.
Summary
In a prospective single-center bronchoscopy study (N=30), COVID-19 patients exhibited significantly higher tracheobronchial vascularization scores on narrow band imaging versus non-COVID pneumonia and nodule controls, with good inter-rater agreement. Findings support bronchial hypervascularization as a contributor to intrapulmonary shunt in COVID-19.
Key Findings
- COVID-19 patients had significantly higher tracheobronchial vascularization scores on NBI compared with non-COVID infection and nodule groups (median 10 vs 5 and 6; p<0.001 and p=0.002).
- Inter-rater agreement for NBI vascularization scoring was good (weighted κ=0.75).
- Authors propose that bronchial hypervascularization contributes to intrapulmonary right-to-left shunt in COVID-19 (AVDS).
Clinical Implications
NBI may aid phenotyping of COVID-19 respiratory failure by identifying bronchial hypervascularization that could inform shunt-focused management strategies alongside standard ARDS care.
Why It Matters
Introduces NBI as a bedside-adjacent tool to visualize airway microvascular changes specific to COVID-19, linking airway vasculature to shunt physiology and the proposed AVDS phenotype.
Limitations
- Small single-center sample limits generalizability
- Cross-sectional design precludes linking imaging findings to gas exchange or outcomes
Future Directions
Correlate NBI-derived vascularization with physiologic shunt, gas exchange metrics, and outcomes; evaluate NBI phenotyping across ARDS etiologies and response to vasomodulatory therapies.
Study Information
- Study Type
- Cohort
- Research Domain
- Diagnosis
- Evidence Level
- III - Prospective monocentric cohort with blinded scoring and comparator groups.
- Study Design
- OTHER