Association between oxygen saturation level during bronchoscopy and post-bronchoscopy adverse events: a retrospective cohort study

Abstract

Background Flexible bronchoscopy is widely used to diagnose and treat various respiratory diseases. However, caution is warranted for post-bronchoscopy adverse events. Although desaturation frequently occurs during bronchoscopy, its clinical impact and the optimal oxygen saturation level during the procedure remain unclear. This study aimed to investigate whether the percutaneous oxygen saturation (SpO2) level during bronchoscopy is associated with the development of post-bronchoscopy respiratory adverse events. Methods In this single-center retrospective cohort study conducted from March 2020 to February 2021, 569 patients were classified into high or low oxygen saturation groups based on the SpO2 level during bronchoscopy. The primary outcome was post-bronchoscopy respiratory adverse events, and secondary outcomes were other post-bronchoscopy adverse events and clinical outcomes. Results Among 569 patients, 458 and 111 patients were classified into the high oxygen saturation (SpO2 > 96%) and low oxygen saturation (SpO2 ≤ 94%) groups, respectively. After propensity score matching, the low oxygen saturation group had more post-bronchoscopy respiratory and febrile adverse events than the high oxygen saturation group. In the multivariable regression analysis, low SpO2 level during bronchoscopy was an independent risk factor for post-bronchoscopy respiratory adverse events (odds ratio = 3.16 [95% confidence interval 1.37–7.30]). In the low oxygen saturation group, the high-risk subgroups for post-bronchoscopy respiratory adverse events were the elderly, women, current smokers, and patients with chronic obstructive pulmonary disease or acute decompensated heart failure before bronchoscopy. There was no significant difference in the length of hospital stay, intensive care unit admission, or mortality between the high and low oxygen saturation groups. Conclusions Close monitoring is recommended for patients with SpO2 ≤ 94% during bronchoscopy due to the increased risk of respiratory adverse events after the procedure.

A prediction model for risk of low oxygen saturation in patients with post-tuberculosis tracheobronchial stenosis during bronchoscopy

“… 34 In this study, the overall incidence of LOS was 26.0% (121/465), which was consistent with that of previous published reports. 15 – 18 Previous studies have identified LOS as an independent risk factor for post-bronchoscopy respiratory adverse events that may worsen clinical outcomes or lead to fatal events. 18 , 35 Additionally, given the considerable restenosis rates even after bronchoscopy, PTTS patients tend to undergo bronchoscopic procedures as many times as needed.…”

“…15 – 18 Previous studies have identified LOS as an independent risk factor for post-bronchoscopy respiratory adverse events that may worsen clinical outcomes or lead to fatal events. 18 , 35 Additionally, given the considerable restenosis rates even after bronchoscopy, PTTS patients tend to undergo bronchoscopic procedures as many times as needed. Research is, therefore, necessary for preoperatively predicting LOS risk in PTTS patients during bronchoscopy.…”

“…In combination with the definition of Kim et al , 18 LOS was defined to be present when SpO 2 ⩽ 94% with the non-transient property. Duration of procedure, that is, time from bronchoscope insertion to bronchoscope removal.…”

“…Therefore, they will undergo bronchoscopic procedures as many times as needed. 12 During bronchoscopic interventions, low oxygen saturation (LOS) is common and the reported incidence of LOS has been as high as 19.5–38.2% in different study settings, 15 – 18 even though multiple oxygen supplementation measures have been developed to prevent LOS. 19 Recent publication undertaken by Kim et al 18 has demonstrated that LOS during bronchoscopy is linked to the increased risk of post-bronchoscopy respiratory adverse events.…”

“… 12 During bronchoscopic interventions, low oxygen saturation (LOS) is common and the reported incidence of LOS has been as high as 19.5–38.2% in different study settings, 15 – 18 even though multiple oxygen supplementation measures have been developed to prevent LOS. 19 Recent publication undertaken by Kim et al 18 has demonstrated that LOS during bronchoscopy is linked to the increased risk of post-bronchoscopy respiratory adverse events. It seems essential for bronchoscopists to identify PTTS patients who may experience LOS during bronchoscopy, by which early and preventive clinical interventions can be applied to reduce the risk of LOS.…”