Oxygenation strategies during flexible bronchoscopy: a review of the literature

Corrado Pelaia,Federico Longhini,Girolamo Pelaia,Eugenio Garofalo,Eugenio Arrighi,Serena Rovida,Andrea Bruni,Gianmaria Cammarota,Paolo Navalesi

doi:10.1186/s12931-021-01846-1

Abstract

During flexible fiberoptic bronchoscopy (FOB) the arterial partial pressure of oxygen can drop, increasing the risk for respiratory failure. To avoid desaturation episodes during the procedure several oxygenation strategies have been proposed, including conventional oxygen therapy (COT), high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV). By a review of the current literature, we merely describe the clinical practice of oxygen therapies during FOB. We also conducted a pooled data analysis with respect to oxygenation outcomes, comparing HFNC with COT and NIV, separately. COT showed its benefits in patients undergoing FOB for broncho-alveolar lavage (BAL) or brushing for cytology, in those with peripheral arterial oxyhemoglobin saturation < 93% prior to the procedure or affected by obstructive disorder. HFNC is preferable over COT in patients with mild to moderate acute respiratory failure (ARF) undergoing FOB, by improving oxygen saturation and decreasing the episodes of desaturation. On the opposite, CPAP and NIV guarantee improved oxygenation outcomes as compared to HFNC, and they should be preferred in patients with more severe hypoxemic ARF during FOB.

Highlights

Flexible fiberoptic bronchoscopy (FOB) is a diagnostic and sometimes therapeutic procedure, commonly performed in patients affected by airway or lung parenchyma disorders
In the attempt to provide some clinical evidences, we have conducted a quantitative synthesis of findings comparing high flow oxygen through nasal cannula (HFNC) with conventional oxygen therapy (COT) and non-invasive ventilation (NIV), separately, with respect to the lowest saturation during procedures and the number of episodes of desaturation
HFNC was shown to be safe in the majority of patients affected by mild-to-moderate acute respiratory failure (ARF) undergoing FOB for either diagnosis or treatment, and in those with lung transplant, while NIV ensured stable oxygenation when FOB was carried out for extended procedures or in patients with more severe ARF

Summary

Introduction

Flexible fiberoptic bronchoscopy (FOB) is a diagnostic and sometimes therapeutic procedure, commonly performed in patients affected by airway or lung parenchyma disorders. FOB has several applications, including plug removal in presence of abundant secretions or ineffective cough, bronchoalveolar lavage (BAL), biopsy, or endoscopic management of bleeding. The majority of patients undergoing FOB suffer from conditions that impair gas exchange such as pneumonia, interstitial lung diseases, as well as lung and bronchial neoplasms. During the procedure arterial partial pressure of oxygen can drop even more than 10–20 mmHg, with. Through a review of the literature, we discuss the rationale and all the alternative oxygenation strategies adopted during FOB. In the attempt to provide some clinical evidences, we have conducted a quantitative synthesis of findings comparing high flow oxygen through nasal cannula (HFNC) with conventional oxygen therapy (COT) and non-invasive ventilation (NIV), separately, with respect to the lowest saturation during procedures and the number of episodes of desaturation.

Results

Discussion

Conclusion