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Prospective Experience of High-flow Nasal Oxygen During Bronchoscopy in 182 Patients

A Feasibility Study

Service, Jennifer A., MBChB, FRCA, FFICM; Bain, Jennifer S., MBChB, FRCA, FFICM; Gardner, Clare P., MBChB, FCARCSI; McNarry, Alistair F., MA, FRCA

Journal of Bronchology & Interventional Pulmonology: January 2019 - Volume 26 - Issue 1 - p 66–70
doi: 10.1097/LBR.0000000000000533
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Background: High-flow nasal oxygen (HFNO) has recently gained popularity during administration of anesthesia in a variety of circumstances, including apneic oxygenation. Fully qualified anesthesiologists provide sedation for our outpatient bronchoscopy service. We adopted this therapy to assess its efficacy providing optimal conditions (using a variety of sedation regimens) for patient and bronchoscopist.

Methods: We aimed to conduct a prospective feasibility evaluation. We collected data from all patients undergoing outpatient bronchoscopy or endobronchial ultrasound with anesthesiologist administered sedation over 21 months. Demographic data, high-flow settings, sedation techniques, and oxygen saturations (SpO2) were collected for each patient. Feedback from the bronchoscopists and anesthesiologists was recorded. Failure of the technique was defined as abandonment of the procedure or prolonged desaturation not amenable to basic airway maneuvers or increase in oxygen flow rate.

Results: All 182 patients underwent satisfactory bronchoscopy or endobronchial ultrasound. Mean age was 63 (±14) years. High-flow rate varied from 10 to 70 L/min. All patients received a remifentanil infusion and 175 (96%) had a propofol infusion. SpO2 before the procedure were lower (96%) than the highest saturation during the procedure with high flow (100%, P<0.0001). Ten patients transiently desaturated to <89%. Some had their flow rates increased, others required a transient jaw thrust, but all patient’s saturations rapidly returned to satisfactory levels. One patient became apneic during sedation. Respiration returned after pausing the sedation and oxygen SpO2 remained above 93% throughout. All bronchoscopists and anesthesiologists were happy with the use of HFNO.

Conclusion: HFNO has been shown to be effective in the outpatient bronchoscopy setting. Further evaluation regarding flow rates and levels of sedation is required.

Anaesthetic Department, St John’s Hospital, NHS Lothian, UK

Disclosure: There is no conflict of interest or other disclosures.

Reprints: Jennifer A. Service, MBChB, FRCA, FFICM, Department of Anaesthesia, St. John’s Hospital, Howden Road West, Livingston, Scotland, EH54 6PP, United Kingdom (e-mail: jennifer.service@nhs.net).

Received November 29, 2017

Accepted June 9, 2018

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