References of included papers, reviews, systematic reviews and meta-analysis were also examined to identify potential studies of interest missed during the primary search.Īll oxygen therapy modalities utilized during flexible bronchoscopy were evaluated. Papers including patients undergoing rigid bronchoscopy were also excluded. We excluded papers published in languages other than English, Italian, French or Spanish as well as case reports or series, review, systematic reviews or meta-analysis and studies published in abstract form. We included all randomized, quasi-randomized, prospective and retrospective studies, published in indexed scientific journals from inception to May 1st, 2021. Study selection and inclusion criteriaĪll cited articles include adult patients, receiving one or more modalities of oxygen support administered during flexible bronchoscopy for any reason (diagnostic or interventional), without restrictions related to the type of bronchoscopy procedure and to the anesthetic risk. The review protocol has been registered in Prospero (CRD42020153343). This review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. In addition, in the attempt to provide some clinical evidences, we have also conducted a quantitative synthesis of findings comparing high flow oxygen through nasal cannula (HFNC) with conventional oxygen therapy (COT) and non-invasive ventilation (NIV), separately, with respect to the lowest saturation during procedures and the number of episodes of desaturation. Through a review of the literature, we discuss the rationale and all the alternative oxygenation strategies adopted during FOB. In order to avoid desaturation episodes, oxygen support provided by conventional therapy or non-invasive ventilation is usually required during and after FOB. During the procedure arterial partial pressure of oxygen can drop even more than 10–20 mmHg, with an increased risk for respiratory failure.
The majority of patients undergoing FOB suffer from conditions that impair gas exchange such as pneumonia, interstitial lung diseases, as well as lung and bronchial neoplasms. FOB has several applications, including plug removal in presence of abundant secretions or ineffective cough, bronchoalveolar lavage (BAL), biopsy, or endoscopic management of bleeding. On the opposite, CPAP and NIV guarantee improved oxygenation outcomes as compared to HFNC, and they should be preferred in patients with more severe hypoxemic ARF during FOB.įlexible fiberoptic bronchoscopy (FOB) is a diagnostic and sometimes therapeutic procedure, commonly performed in patients affected by airway or lung parenchyma disorders. HFNC is preferable over COT in patients with mild to moderate acute respiratory failure (ARF) undergoing FOB, by improving oxygen saturation and decreasing the episodes of desaturation. COT showed its benefits in patients undergoing FOB for broncho-alveolar lavage (BAL) or brushing for cytology, in those with peripheral arterial oxyhemoglobin saturation < 93% prior to the procedure or affected by obstructive disorder.
We also conducted a pooled data analysis with respect to oxygenation outcomes, comparing HFNC with COT and NIV, separately.
By a review of the current literature, we merely describe the clinical practice of oxygen therapies during FOB. To avoid desaturation episodes during the procedure several oxygenation strategies have been proposed, including conventional oxygen therapy (COT), high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV). During flexible fiberoptic bronchoscopy (FOB) the arterial partial pressure of oxygen can drop, increasing the risk for respiratory failure.