Abstract
BackgroundHypoxemia frequently occurs during bronchoscopy. High-flow nasal cannula (HFNC) oxygen therapy may be a feasible alternative to prevent the deterioration of gas exchange during bronchoscopy. With the convenience of clinical use in mind, we modified an HFNC using a single cannula. This clinical trial was designed to test the hypothesis that a modified HFNC would decrease the proportion of patients with a single moment of peripheral arterial oxygen saturation (SpO2) < 90% during bronchoscopy.MethodsIn this single-center, prospective randomized controlled trial, hospitalized patients in the respiratory department in need of diagnostic bronchoscopy were randomly assigned to a modified HFNC oxygen therapy group or a conventional oxygen therapy (COT) group. The primary outcome was the proportion of patients with a single moment of SpO2 < 90% during bronchoscopy.ResultsEight hundred and twelve patients were randomized to the modified HFNC (n = 406) or COT (n = 406) group. Twenty-four patients were unable to cooperate or comply with bronchoscopy. Thus, 788 patients were included in the analysis. The proportion of patients with a single moment of SpO2 < 90% during bronchoscopy in the modified HFNC group was significantly lower than that in the COT group (12.5% vs. 28.8%, p < 0.001). There were no significant differences in the fraction of inspired oxygen between the two groups. The lowest SpO2 during bronchoscopy and 5 min after bronchoscopy in the modified HFNC group was significantly higher than that in the COT group. Multivariate analysis showed that a baseline forced vital capacity (FVC) < 2.7 L (OR, 0.276; 95% CI, 0.083–0.919, p = 0.036) and a volume of fluid instilled > 60 ml (OR, 1.034; 95% CI, 1.002–1.067, p = 0.036) were independent risk factors for hypoxemia during bronchoscopy in the modified HFNC group.ConclusionsA modified HFNC could decrease the proportion of patients with a single moment of SpO2 < 90% during bronchoscopy. A lower baseline FVC and large-volume bronchoalveolar lavage may predict desaturation during bronchoscopy when using a modified HFNC.Trial registration ClinicalTrials. Gov: NCT02606188. Registered 17 November 2015.
Highlights
The remaining 812 patients were randomized to the modified High-flow nasal cannula (HFNC) (n = 406) or conventional oxygen therapy (COT) group (n = 406)
Baseline spirometry revealed the ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC), and the percent of predicted diffusing capacity of lungs for carbon monoxide (DLco) was 73.4% and 78.1% lower than normal, respectively
There were no significant differences between the two groups with respect to age, sex, body mass index (BMI), smoking history, indication for bronchoscopy, vital signs, arterial blood gas values, baseline spirometry, or laboratory parameters
Summary
With the conveni‐ ence of clinical use in mind, we modified an HFNC using a single cannula This clinical trial was designed to test the hypothesis that a modified HFNC would decrease the proportion of patients with a single moment of peripheral arte‐ rial oxygen saturation (SpO2) < 90% during bronchoscopy. The proportion of patients with a single moment of S pO2 < 90% during bronchoscopy in the modified HFNC group was significantly lower than that in the COT group (12.5% vs 28.8%, p < 0.001). Multivariate analysis showed that a baseline forced vital capacity (FVC) < 2.7 L (OR, 0.276; 95% CI, 0.083–0.919, p = 0.036) and a volume of fluid instilled > 60 ml (OR, 1.034; 95% CI, 1.002–1.067, p = 0.036) were independent risk fac‐ tors for hypoxemia during bronchoscopy in the modified HFNC group
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