Hyperkapnie und Hypoxämie während flexiblem EBUS bei Patienten mit und ohne COPD

Strohleit, Daniel; Galetin, Thomas; Magnet, Friederike Sophie; Stoelben, Erich

doi:10.1055/s-0039-3403243

Cited by 1 publication

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“…Apnoea phases and resulting hypercapnia can therefore not adequately be detected. One third of the hypercapnic episodes appear delayed up to one hour after the end of FB [ 5 ]. Patients with pre-existing lung diseases (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review

Strohleit¹,

Galetin²,

Kosse³

et al. 2021

BMC Pulm Med

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Background Patients undergoing bronchoscopy in spontaneous breathing are prone to hypoxaemia and hypercapnia. Sedation, airway obstruction, and lung diseases impair respiration and gas exchange. The restitution of normal respiration takes place in the recovery room. Nonetheless, there is no evidence on the necessary observation time. We systematically reviewed current guidelines on bronchoscopy regarding sedation, monitoring and recovery. Methods This review was registered at the PROSPERO database (CRD42020197476). MEDLINE and awmf.org were double-searched for official guidelines, recommendation or consensus statements on bronchoscopy from 2010 to 2020. The PICO-process focussed on adults (Patients), bronchoscopy with maintained spontaneous breathing (Interventions), and recommendations regarding the intra- and postprocedural monitoring and sedation (O). The guideline quality was graded. A catalogue of 54 questions was answered. Strength of recommendation and evidence levels were recorded for each recommendation. Results Six guidelines on general bronchoscopy and three expert statements on special bronchoscopic procedures were identified. Four guidelines were evidence-based. Most guidelines recommend sedation to improve the patient’s tolerance. Midazolam combined with an opioid is preferred. The standard monitoring consists of non-invasive blood pressure, and pulse oximetry, furthermore electrocardiogram in cardiac patients. Only one guideline discusses hypercapnia and capnometry, but without consensus. Two guidelines discuss a recovery time of two hours, but a recommendation was not given because of lack of evidence. Conclusion Evidence for most issues is low to moderate. Lung-diseased patients are not represented by current guidelines. Capnometry and recovery time lack evidence. More primary research in these fields is needed so that future guidelines may address these issues, too.

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Section: Introductionmentioning

confidence: 99%

“…Patients with pre-existing lung diseases (e.g. COPD) are even more at risk to develop substantial hypercapnia during and after FB [ 5 , 6 ]. Thus, the patients need to be monitored after FB, too, to determine the safe time of discharge in ambulant patients or of transfer to the ward in hospitalised patients.…”

Section: Introductionmentioning

confidence: 99%