High-flow nasal cannula for reducing hypoxemic events in patients undergoing bronchoscopy: A systematic review and meta-analysis of randomized trials

Abstract

Background 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. Methods 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. Results 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. Conclusions HFNC may reduce the incidence of hypoxemic events and improve oxygenation in patients undergoing bronchoscopy.

High-Flow vs. Low-Flow Nasal Cannula in Reducing Hypoxemic Events During Bronchoscopic Procedures: A Systematic Review and Meta-Analysis

“…One primary and 10 secondary clinically relevantend points were addressed. Our study included almost 5 times more patients compared to an analogous meta-analysis by Su et al ( 30 ). Therefore it had greater statistical power to address more clinically relevant outcomes like pneumothoraxes, mean SpO2, and other significant cardiorespiratory parameters in post bronchoscopy recovery time that have not been addressed in previous analogous studies ( 30 ).…”

“…Our study included almost 5 times more patients compared to an analogous meta-analysis by Su et al (30). Therefore it had greater statistical power to address more clinically relevant outcomes like pneumothoraxes, mean SpO2, and other significant cardiorespiratory parameters in post bronchoscopy recovery time that have not been addressed in previous analogous studies (30). At the same time, our study showed significantly more procedure interruptions in the LFNC group, evidence that the study of Chien-Ling Su et al failed to show, most probably because of the limited number of included patients (257) (30).…”

“…Therefore it had greater statistical power to address more clinically relevant outcomes like pneumothoraxes, mean SpO2, and other significant cardiorespiratory parameters in post bronchoscopy recovery time that have not been addressed in previous analogous studies ( 30 ). At the same time, our study showed significantly more procedure interruptions in the LFNC group, evidence that the study of Chien-Ling Su et al failed to show, most probably because of the limited number of included patients (257) ( 30 ). Pelaia et al, in a recent systematic review and meta-analysis ( 31 ) addressed the benefits of HFNC vs. LFNC vs. continuous positive airway pressure (CPAP) modalities.…”

High flow nasal cannula for patients undergoing bronchoscopy and gastrointestinal endoscopy: A systematic review and meta-analysis

“…Several previous systematic reviews have demonstrated the effect of HFNC during the endoscopic procedure. Su et al ( 38 ) investigated the application of HFNC in patients undergoing bronchoscopy and concluded that HFNC could reduce the incidence of hypoxemic events and improve oxygenation. However, all of their included studies had a small sample size with a total of 257 patients (5 RCTs), and no subgroup analysis was performed due to the lack of sufficient data.…”

Should We Use High-Flow Nasal Cannula in Patients Receiving Gastrointestinal Endoscopies? Critical Appraisals through Updated Meta-Analyses with Multiple Methodologies and Depiction of Certainty of Evidence

“…High-flow gas rates may generate small positive end-expiratory pressure (PEEP) by creating tracheal gas insufflation which prevents atelectasis [7]. HFNC has been studied in patients receiving bronchoscopy [8], awake craniotomy [9], and dental procedures [10] under IV sedation.…”