Assessment of High Flow Nasal Cannula Oxygenation in Endobronchial Ultrasound Bronchoscopy: A Randomized Controlled Trial. Issue 2 (April 2021)

• Record Type: Journal Article
• Authors: Irfan, Mujammil; Ahmed, Mohammed; Breen, David
• Is Part Of: Journal of bronchology & interventional pulmonology. Volume 28:Issue 2(2021)
• Publication Date: 2021-04
• Subjects: EBUS-TBNA bronchoscopy -- high flow nasal cannula -- supplemental oxygen; Bronchoscopy -- Periodicals; Lungs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Lung Diseases -- surgery -- Periodicals; Diagnostic Techniques, Respiratory System -- Periodicals; Bronchi; Bronchoscopy; Lungs -- Diseases; Periodicals; 616.23
• DOI: 10.1097/LBR.0000000000000719
• Languages: English
• ISSNs: 1944-6586

Abstract

Abstract : Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been widely implemented in evaluating mediastinal disease. EBUS-TBNA is performed with low flow oxygen systems or general anesthesia. Little data exist on use of high flow nasal cannula (HFNC) in EBUS-TBNA. Methods: This was a single center parallel group randomized controlled trial comparing oxygenation through HFNC (Optiflow) against nasal prongs during EBUS. The primary end-point was the drop in oxygen saturations from procedure commencement, recorded by pulse oximetry, to the lowest level during EBUS-TBNA. Secondary end-points included changes in venous blood carbon dioxide, lowest oxygen saturation, changes in end-tidal CO2 during the procedure, intubation within 8 hours of the procedure and patient experience reported on a visual analog scale. Results: We randomized 20 patients to each study arm. The primary outcome of oxygen desaturation during the procedure was statistically significant with a difference of 7.7 percentage points (95% confidence interval, 4.91-10.49, P <0.001). The secondary outcome measure of lowest oxygen saturation was also statistically significant with a difference of −9.2 (95% confidence interval, −11.96 to −6.44, P <0.001). There was no difference in safety outcomes, visual analog scale score or in their willingness to return for repeat procedure. Conclusion: This single institution study in a university, tertiary referral center confirms that EBUS-TBNA performed with HFNC is associated with a statistically significant lower drop in oxygen saturation. Additional studies are needed to assess if this translates into improved clinical outcomes postprocedure. Abstract : Supplemental Digital Content is available in the text.