Management of Arterial Hypoxemia Induced by Fiberoptic Bronchoscopy

Albertini, Robert E.; Harrell, James H.; Moser, Kenneth Μ.

doi:10.1378/chest.67.2.134

Cited by 45 publications

(9 citation statements)

References 13 publications

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“…Arterial hypoxaemia and thrombocytopenia represent significant risk factors encountered in immunocompromised patients undergoing fibreoptic bronchoscopy (Hanson et al, 1976). Supplemental oxygen, found to be useful by others (Albertini et al, 1975;Zavala, 1975) to protect against severe hypoxaemia during bronchoscopy, appeared to protect hypoxaemic patients in this study. Platelet transfusions administered during and immediately after bronchoscopy in severely thrombocytopenic patients appeared to prevent severe pulmonary haemorrhage in our study.…”

Section: Discussionsupporting

confidence: 58%

Diagnostic fibreoptic bronchoscopy in the immunocompromised host with pulmonary infiltrates.

Matthay¹,

Farmer²,

Odero³

1977

Thorax

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Section: Discussionsupporting

confidence: 58%

Diagnostic fibreoptic bronchoscopy in the immunocompromised host with pulmonary infiltrates.

Matthay¹,

Farmer²,

Odero³

1977

Thorax

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“…It is common practice to administer supplemental oxygen via intranasal route, and to switch to high flow oxygen delivery by mask if patients have low baseline pulse oximetry. Pulse oximetry is monitored continuously during flexible bronchoscopy and oxygen requirements adjusted if necessary 11 . During hypoxic episodes, suction is suspended to avoid ‘suction steal’ as 40% and 75% reduction in tidal volume might occur when 12.5‐cm H 2 O and 21‐cm H 2 O of vacuum is applied through the working channel 12 .…”

Section: Diagnostic Bronchoscopymentioning

confidence: 99%

“…Pulse oximetry is monitored continuously during flexible bronchoscopy and oxygen requirements adjusted if necessary. 11 During hypoxic episodes, suction is suspended to avoid 'suction steal' as 40% and 75% reduction in tidal volume might occur when 12.5-cm H2O and 21-cm H2O of vacuum is applied through the working channel. 12 Caution should be exercised regarding high flow oxygen administration to patients with chronic hypercapnia as well as judicious use of sedatives and narcotics that can depress the respiratory centre.…”

Section: Diagnostic Bronchoscopymentioning

confidence: 99%

Management of complications from diagnostic and interventional bronchoscopy

2009

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From the humble beginnings as a mere curiosity, the art of bronchoscopy has progressed at a rapid pace.The millennium ushers in new technologies and refinements in established techniques to facilitate early detection of cancer, precise targeting of pulmonary nodules and infiltrates, near-total staging of the mediastinum with combined endoscopic modalities and more effective palliation of inoperable tumours. Bronchoscopists are faced with an increasing myriad of tools and equipment, each promising to carry out better than the previous. It is opportune to review the complications of established bronchoscopic techiques and how to manage them as well as new complications associated with novel technologies. In this article, we provide a concise overview of diagnostic and therapeutic bronchoscopic modalities, discussion of associated complications and their management strategies.

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“…Multiple factors contribute to hypoxemia during bronchoscopy [9,10,11,12,13]. The bronchoscope itself reduces the cross-sectional area of the airway, leading to airflow limitation.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility of Tracheal Oxygen Supplementation during Flexible Bronchoscopy

et al. 2016

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Background: Hypoxemia is a frequent adverse event occurring during flexible bronchoscopy and is usually prevented by close monitoring and, if needed, oxygen supplementation by nasal cannula. Objective: We aim to demonstrate that tracheal oxygen supplementation during flexible bronchoscopy is a feasible, safe and effective method to restore oxygen saturation levels after oxygen desaturation. Methods: In a first phase, we compare oxygen supplementation by the tracheal or nasal route in a single blinded cross-over design in healthy volunteers. In a second phase, we study patients referred for diagnostic flexible bronchoscopy, who desaturate despite oxygen supplementation by nasal cannula, in order to assess the ability to correct hypoxemia through tracheal oxygen supplementation. Results: In the first phase, the mean capillary partial pressure of oxygen was 181 mm Hg when oxygen at a flow rate of 4 liters/min was administered by the tracheal route, compared to 125 mm Hg by the nasal route (p < 0.001). The capillary partial pressure of carbon dioxide was not significantly different. During 950 bronchoscopic procedures in the second phase of the trial, 30 patients desaturated below 90% despite oxygen supplementation by nasal cannula. In 22 out of these 30 patients, switching to the tracheal route resulted in a correction of the saturation within 120 s. In the remaining 8 patients, saturation levels were corrected after increasing the oxygen flow rate to 4 liters/min. After restoring saturation levels, the bronchoscopy could be completed in 25 of 30 patients. Conclusions: Tracheal oxygen supplementation is safe, feasible and an effective way to restore oxygen saturation levels during flexible bronchoscopy.

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Management of Arterial Hypoxemia Induced by Fiberoptic Bronchoscopy

Cited by 45 publications

References 13 publications

Diagnostic fibreoptic bronchoscopy in the immunocompromised host with pulmonary infiltrates.

Diagnostic fibreoptic bronchoscopy in the immunocompromised host with pulmonary infiltrates.

Management of complications from diagnostic and interventional bronchoscopy

The Feasibility of Tracheal Oxygen Supplementation during Flexible Bronchoscopy

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