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

Abstract

IntroductionHigh-flow nasal cannula (HFNC) oxygenation method has been proven to be successful in oxygenation of patients with respiratory failure and has exhibited clinical superiority compared to low-flow nasal cannula (LFNC).MethodsWe performed a systematic review and meta-analysis to evaluate the potential favorable impact of HFNC oxygenation during bronchoscopy and related procedures like endobronchial ultrasound-transbronchial needle aspiration. Only randomized control trials (RCTs) were included in the meta-analysis.ResultsSix randomized control trials with 1,170 patients were included in this meta-analysis. Patients who underwent bronchoscopy with the use of high-flow nasal cannula experienced less hypoxemic events/desaturations, less procedural interruptions and pneumothoraxes compared to patients under low-flow nasal cannula treatment. This beneficial effect of HFNC in hypoxemic events was persistent 10 min after the end of procedure.ConclusionThe high-flow nasal cannula (HFNC) oxygenation method could reduce hypoxemic events and related peri- and post-bronchoscopic complications.

Optimal flow of high-flow nasal cannula oxygenation to prevent desaturation during sedation for bronchoscopy: a randomized controlled study

“…To the best of our knowledge, this is the first report of the optimal oxygen flow rate for HFNC to prevent desaturation during bronchoscopy. Although several studies have reported that HFNC can reduce the incidence of desaturation during bronchoscopy, 2 , 7 – 11 none reported an ideal oxygen flow rate.…”

“…As compared to conventional therapy, HFNC can reduce the incidence of hypoxemia during sedation for bronchoscopy. 2 , 7 – 11 However, there is currently no consensus on an optimal flow rate. We hypothesized that increasing the oxygen flow rate can prevent desaturation during bronchoscopy.…”

High-Flow Nasal Cannula Therapy as an Adjuvant Therapy for Respiratory Support during Endoscopic Techniques: A Narrative Review

“…FOB is a fundamental diagnostic and therapeutic procedure in the assessment of the airways and lung parenchyma. It is an interventional technique that, like all procedures, can be associated with complications, including the development of hypoxaemia [ 6 , 7 , 8 , 10 , 11 , 27 , 28 ]. Hypoxaemia can also lead to serious cardiac events such as atrial or ventricular arrhythmias [ 8 ].…”

“… Other circumstances that arise during fiberoptic bronchoscopy (FOB) include: The effective airway diameter is reduced when advancing the bronchoscope beyond the glottis; suctioning during FOB can result in alveolar recruitment loss and atelectasis formation. Instillation of local anesthetics or saline solution during certain procedures, such as bronchoalveolar lavage (BAL), may cause alveolar flooding and affect the ventilation/perfusion ratio [ 6 , 7 , 8 , 9 ]. …”

“…Instillation of local anesthetics or saline solution during certain procedures, such as bronchoalveolar lavage (BAL), may cause alveolar flooding and affect the ventilation/perfusion ratio [ 6 , 7 , 8 , 9 ].…”