Abstract
Patients undergoing bronchoscopic procedures may develop hypoxemia and severe complications. High-flow nasal cannula (HFNC) may prevent hypoxemic events during bronchoscopy. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the effectiveness of HFNC in these patients. We conducted a search in PubMed, Embase, and the Cochrane Library for RCTs published before November 2021. Individual effect sizes were standardized, and a meta-analysis was performed to calculate the pooled effect size using random-effects models. The primary outcome was the incidence of hypoxemic events (oxygen saturation [SpO2] < 90%) during bronchoscopy. Secondary outcomes included the incidence of interrupted bronchoscopy due to desaturation, lowest SpO2 during bronchoscopy, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), end-tidal CO2 (EtCO2) at the end of bronchoscopy, and the incidence of intubation after the procedure. Five trials involving 257 patients were reviewed. The incidence of hypoxemic events was lower in the HFNC group than in the conventional oxygen therapy group (risk ratio, 0.25; 95% confidence interval [CI], 0.14-0.42). The lowest SpO2 during the procedure was significantly higher in the HFNC group than in the conventional oxygen therapy group (weighted mean difference [WMD], 7.12; 95% CI, 5.39-8.84). PaO2 at the end of the procedure was significantly higher in the HFNC group than in the conventional oxygen therapy group (WMD, 20.36; 95% CI, 0.30-40.42). The incidence of interrupted bronchoscopy due to desaturation, PaCO2 and EtCO2 at the end of the procedure, and the incidence of intubation after the procedure were not significantly different between groups. HFNC may reduce the incidence of hypoxemic events and improve oxygenation in patients undergoing bronchoscopy.
Highlights
Hypoxemia is one of the complications in patients undergoing bronchoscopy
Secondary outcomes included the incidence of interrupted bronchoscopy due to desaturation, lowest SpO2 during bronchoscopy, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), end-tidal CO2 (EtCO2) at the end of bronchoscopy, and the incidence of intubation after the procedure
The incidence of hypoxemic events was lower in the High-flow nasal cannula (HFNC) group than in the conventional oxygen therapy group
Summary
Hypoxemia is one of the complications in patients undergoing bronchoscopy. Sedation and occlusion of the bronchi during the procedure reduce the respiratory drive and lead to hypoventilation [1]. Patients with pulmonary complications after bronchoscopic procedures occasionally have a risk of hypoxemic events that require rescue airway interventions [2]. Complications of bronchoscopy, such as refractory hypoxemia and respiratory depression, can be debilitating without careful monitoring [2,3,4]. Conventional oxygen therapy was usually adopted for patients undergoing diagnostic or therapeutic bronchoscopy, but desaturation would occasionally occur due to impaired respiratory drive and hypoventilation [2,3,4]. High-flow nasal cannula (HFNC) may replace conventional oxygen supply due to the more consistent fraction of inspired oxygen [5, 6]. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the effectiveness of HFNC in these patients
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