High flow nasal cannula versus standard low flow nasal oxygen during flexible bronchoscopy in children: A randomized controlled trial

Abstract

Background: Hypoxemia is the most frequent complication of fiberoptic bronchoscopy (FB) in children. Guidelines recommend oxygen supplementation and conventional nasal prongs (NC) are used for this purpose. The aim of this study was to evaluate if the use of high-flow nasal cannula therapy (HFNC) in children undergoing FB result in a lower incidence of hypoxemia than standard oxygen administration.Methods: Patients aged 1 month-16 years undergoing elective FB were included in a prospective randomized controlled, nonblinded, single-center clinical trial and randomly assigned to receive oxygen via NC or HFNC. Patients' baseline characteristics were recorded pre-bronchoscopy. The primary outcome was oxygen desaturation during the procedure defined as saturation less than 94%.Results: An intention to treat analysis for 53 patients receiving NC and 51 receiving HFNC, showed HFNC patients were less likely to have hypoxemia than were NC patients (p = .011), with an absolute risk reduction of 0.27 (95% confidence interval[CI]: 0.08-0.45) and a number needed to treat of 3.75 (95% CI: 2.22-12.04).Moderate hypoxemia (SpO 2 ≥ 90% and <94%, and <60 s) was observed significantly less often with HFNC than with NC (p = .012). Severe hypoxemia (SpO 2 < 90% and >30 s) was not different between groups. Patients undergoing bronchoalveolar lavage (BAL) presented fewer desaturations with HFNC (p = .0003).

Effect of high‐flow nasal oxygen on hypoxaemia during procedural sedation: a systematic review and meta‐analysis

“…21203/rs.3.rs-989822/v1], two dental trials [23,40] and one endovascular trial [25]. Three of the trials studied children [21,23,26], one each in cardiology [21], bronchoscopy [26] and dental procedures [23] with a total sample size of 329 patients. Four trials assessed patients at high risk of developing hypoxaemia [9,22,35,37] in one [38] and a combination of low-flow nasal oxygen and bite block oxygen insufflation in one [37].…”

A new oxygen therapy support device for infant bronchoscopy?

“…Abulebda et al 1 found that the incidence of transient hypoxemia in infants was significantly higher than that in toddlers and children (46%, 6%, and 7%, respectively), so the clinical application of FB in infants was limited to some extent. We read with interest the article of Sharluyan et al, 2 which confirmed that high‐flow nasal cannula (HFNC) was safe, well tolerated, and effective in children's soft bronchoscopy, especially in children requiring bronchoalveolar lavage (BAL). Due to the lack of HFNC in our hospital, we improved T‐piece resuscitators (TPR) for infant bronchoscopy based on the characteristics of HFNC.…”

“…Abulebda et al 1 found that the incidence of transient hypoxemia in infants was significantly higher than that in toddlers and children (46%, 6%, and 7%, respectively), so the clinical application of FB in infants was limited to some extent. We read with interest the article of Sharluyan et al, 2 pressure artificial respiration of premature infants and newborns. The current instructions for TPR have clearly indicated that it can be used in infants ranging from 450 g to 10 kg.…”

Comparison of the Effects of Esketamine/Propofol and Sufentanil/Propofol on the Incidence of Intraoperative Hypoxemia during Bronchoscopy: Protocol for a Randomized, Prospective, Parallel-Group Trial

“…Hypoxemia is the most frequent complication, and the risk in patients undergoing this procedure is approximately 26–69.1%, due to the different choices of anesthesia and inconsistent indicators for evaluating hypoxemia [ 12 , 20 , 21 , 22 , 23 , 24 , 25 ]. Many patients could not tolerate a bronchoscopic procedure without sedation for anxiety and intense stimulation.…”