Oxygen Desaturation during Fiberoptic Bronchoscopy in Pediatric Patients

Schnapf, Bruce M.

doi:10.1378/chest.99.3.591

Cited by 64 publications

(57 citation statements)

References 9 publications

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“…14,17 it also demonstrates that a significant decrease in ET-Pco 2 can be seen during this procedure. The measurement of ET-Pco 2 is now widely used to monitor the ventilatory status of patients, since it is well correlated with arterial CO 2 pressure and is not significantly affected by oxygen flow rate.…”

Section: Discussionmentioning

confidence: 67%

“…A decrease in Spo 2 during FFB has been previously reported. 17 The changes in ET-Pco 2 values observed during FFB could be derived from (a) tachypnea and increased minute ventilation secondary to airway stimulation, (b) hypoventilation due to airway obstruction and/or sedation, or (c) significant changes in pulmonary perfusion arising from increased airway resistance. 26 Abnormally low end-tidal values (below 35 mmHg), most often reflect hyperventilation but may also be caused by an increase in dead space with normal Paco 2 .…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16] A decrease in oxygen saturation during FFB is most frequently found when the instrument is positioned at the carina where consequent hypoventilation, hypoxemia and the need for supplemental oxygen may be expected. 17 These patients receive oxygen during the procedure via a nasal canula. Under these circumstances, Spo 2 can be normalized while the hypoventilation remains unrecognized.…”

Section: Introductionmentioning

confidence: 99%

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End-tidal carbon dioxide monitoring during flexible fiberoptic bronchoscopy

Taher

Kamash²

2006

Mary Slessor Journal of Medicine

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Background:In recent years, Flexible Fiberoptic Bronchoscopy (FFB) has been applied for diagnostic and some therapeutic purposes. During FFB and even in the presence of supplemental oxygen, hypoventilation leading to hypoxia and desaturation may occur; this is aggravated by the use of suction. Arterial oxygen saturation is usually monitored with pulse oximetry (Spo 2 ) during FFB; End-Tidal Pco 2 (ET-Pco 2 ) monitoring is not routinely used. Methods: Two-hundred patients were studied between May 1998 till April 2003, at the divisions of chest surgery and Pulmonology at King Hussein Medical Center, (KHMC). Their ages 53±19 years (mean±SD), underwent FFB and received supplemental oxygen during various stages of FFB: 1-before and during installation of lidocaine on the vocal cords, 2-during passage of instrument into the trachea, RMB, IMB, 3-during bronchoalveolar lavage, bronchial biopsy, Trans Bronchial Biopsy (TBB), and 4-at the final stages of FFB. ET-Pco 2 changes were studied with a capnograph and Spo 2 using a pulse oximeter simultaneously and the results were recorded. Results: Mean ET-Pco 2 significantly decreased from 28.7±4.5 mmHg before FFB to 28±5.7 mmHg, 27.9±5.5 mmHg, 27.5±5.6 mmHg, 27.1±4.5 mmHg, 27.9±5.3 mmHg during bronchoscopy of the Right Main Bronchus (RMB), Left Main Bronchus (LMB), bronchial washing, bronchial biopsy and Trans Bronchial Biopsy (TBB), and at the termination of FFB, respectively (p<0.05). In 118 patients (59%), the decrease of ET-Pco 2 was equal to or greater than 4 mmHg; in 105 patients (52.5%) the amount of decrease in Spo 2 was = 5% and in 32 patients (16%), Spo 2 decreased = 10%. No correlation was found between decreasing ET-Pco 2 and Spo 2 during the procedure. Conclusion: ET-Pco 2 and Spo 2 decreased during bronchoscopy. We also speculate that this reflects airway obstruction by the instrument. Further studies and more experimental analysis in this field is recommended.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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End-tidal carbon dioxide monitoring during flexible fiberoptic bronchoscopy

Taher

Kamash²

2006

Mary Slessor Journal of Medicine

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“…All these procedures are generally well tolerated in the pediatric intensive care population, although lung oxygenation often deteriorates. [2][3][4] In fact, in a study by Burmester and Mok, 5 12% of critically ill and mechanically ventilated infants and toddlers submitted to NB-BAL had an increased oxygenation index 1 hr after the procedure. In that study, these side effects were mainly found in children with a collapse-prone lung disease, suggesting that NB-BAL with saline instillation and suctioning augmented the collapse tendency, what has also been observed in patients with severe lung disease.…”

Section: Introductionmentioning

confidence: 99%

Inflation lung mechanics deteriorates markedly after saline instillation and open endotracheal suctioning in mechanically ventilated healthy piglets

Cunha-Goncalves

Perez-de-Sa

Ingimarsson

et al. 2006

Pediatric Pulmonology

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Summary. Introduction Non-bronchoscopic bronchoalveolar lavage is an alternative to diagnostic bronchoscopy in pediatric patients, as fiberoptic bronchoscopes with aspiration channels are too large for small infants. There are many variations of the method in clinical practice, and saline instillation followed by open endotracheal suctioning is still commonly used. Lung function can deteriorate with these procedures, and we have investigated the effects on lung mechanics and oxygenation in healthy piglets. Methods The lungs of anesthetized and mechanically ventilated piglets were recruited with CPAP 35 cmH 2 O. Thereafter we instilled 5 ml of saline into the endotracheal tube, followed by three breaths from the ventilator. Saline was retrieved through a suction catheter wedged far distally in the airway. The procedure was followed by a new recruitment maneuver. Complete inspiratory/expiratory pressure-volume loops (PV-loops) were obtained just before and 5 min after saline instillation. Arterial blood gases were collected at equivalent times in 14 similar piglets submitted to exactly the same procedure. Results The inspiratory limb of the PV-loops changed markedly, as the lower inflection point was displaced towards higher pressures (P ¼ 0.004), and hysteresis measured at 15 and 30 cmH 2 O increased (P ¼ 0.004 and P ¼ 0.012, respectively). Although PaO 2 decreased significantly (P ¼ 0.001), values after saline instillation/ suctioning were still in the high normal range, that is, 22.2 AE 2.6 kPa. Conclusions Opening pressures of the lungs increase markedly after saline instillation/suctioning in healthy piglets. In this situation, adequate recruitment maneuvers and PEEP might prevent lung collapse and deteriorations in arterial oxygenation.

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“…A team approach with an anaesthesiologist has now become standard in many paediatric bronchoscopy suites, and is most helpful in small infants and critically ill children. Young children are at increased risk for hypoxaemia and hypercapnia during the procedure due to the small size and increased collapsibility of their airways, and the proportionally much higher resistance imposed by the bronchoscope [1]. Sedatives and anaesthetic drugs utilised to provide comfort during the procedure are also more likely to impair respiratory drive in young children due to the immaturity and sensitivity of the respiratory control system in this age group [2].…”

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confidence: 99%

Use of continuous positive airway pressure during flexible bronchoscopy in young children

Trachsel

Erb²,

Frei³

et al. 2005

Eur Respir J

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Young children are at increased risk for hypoxaemia and hypercapnia during flexible bronchoscopy due to the small size and increased collapsibility of their airways. Various strategies are used to prevent hypoventilation and to provide oxygen during the procedure. The aim of this study was to assess the impact of continuous positive airway pressure (CPAP) on ventilation during flexible bronchoscopy in infants and young children.Tidal breathing was measured in 16 spontaneously breathing and deeply sedated children, aged 3-25 months, by ultrasound spirometry via an airway endoscopy mask. Measurements were made with the tip of the bronchoscope positioned in the pharynx with no CPAP, and in midtrachea with 0, 5 and 10 cmH 2 O of CPAP.Transition of the bronchoscope through the vocal cords was associated with significant decreases of tidal volumes (5.0¡0.5 versus 3.4¡0.5 mL?kg -1 ), peak tidal expiratory flows (78¡12 versus 52¡10 mL?s -1 ) and peak tidal inspiratory flows (98¡15 versus 66¡12 mL?kg -1). CPAP (5-10 cmH 2 O) induced almost complete reversal of these changes.In conclusion, it is shown here that flexible bronchoscopy in spontaneously breathing young children is associated with significant decreases in tidal volume and respiratory flow. These changes are largely reversible with continuous positive airway pressure.

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Oxygen Desaturation during Fiberoptic Bronchoscopy in Pediatric Patients

Cited by 64 publications

References 9 publications

End-tidal carbon dioxide monitoring during flexible fiberoptic bronchoscopy

End-tidal carbon dioxide monitoring during flexible fiberoptic bronchoscopy

Inflation lung mechanics deteriorates markedly after saline instillation and open endotracheal suctioning in mechanically ventilated healthy piglets

Use of continuous positive airway pressure during flexible bronchoscopy in young children

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