Abstract: BACKGROUND: Patients with COPD are at increased risk for developing additional respiratory comorbidities associated with smoking, and are thus prone to undergo flexible bronchoscopy. However, COPD patients have increased periprocedural complications risk and lower oxygen saturation during bronchoscopy. METHODS: This was an investigator-initiated, single-centre, open-label randomised controlled trial designed to assess the benefits of high-flow nasal oxygen compared to conventional low-flow oxygen by nasal cannula during conscious sedation for bronchoscopy in patients with COPD. Low flow was supplied at a starting rate of 4 L.min(-1) and gradually increased up to 12 L.min(-1) to maintain peripheral oxygen saturation (S (pO(2)) ) >90%. High flow delivered starting at a rate of 60 L.min(-1) and an inspiratory oxygen fraction of 0.6 was increased up to 80 L.min(-1) to preserve S (pO(2)) >90%. The primary end-point was cumulative hypoxaemia time. RESULTS: We randomised 600 COPD cases with a median (interquartile range (IQR)) age of 69.0 (62.0-76.0) years to either high flow (n=295) or low flow (n=305). The cumulative hypoxaemia time was 53% lower in the high-flow group (1.8% (95% CI 1.5-2.2%) versus 3.8% (95% CI 3.2-4.5%) of monitoring time; p<0.001). Additionally, the high-flow group experienced a median (IQR) of 3.0 (1.0-6.0) hypoxaemia events (S (pO(2)) <90%) compared to 6.0 (3.0-10.0) in the low-flow group (p<0.001). The low-flow group had five-fold higher odds of experiencing hypoxaemia during bronchoscopy, (OR 5.1, 95% CI 3.2-8.2; p<0.001). CONCLUSION: High flow is feasible, decreases cumulative hypoxaemia time and reduces hypoxaemia events during bronchoscopy in patients with COPD but does not impact patient comfort.
Tags: *Bronchoscopy/methods/adverse effects, *Hypoxia/prevention & control, *Oxygen Inhalation Therapy/methods, *Oxygen/blood, *Pulmonary Disease, Chronic Obstructive/therapy/complications, Aged, Berline-Chemie/Menarini, Boehringer Ingelheim, Chiesi, CSL Behring, Curetis AG,, Cannula, D. Stolz is the GOLD representative for Switzerland. The remaining authors have, Female, Foundation, lecture honoraria from AstraZeneca, GSK and Sanofi, travel support, from OrPha Swiss, MSD, Gebro Pharma and Janssen, and advisory board participation, GSK, Merck, MSD, Novartis, Sanofi, Vifor and Roche, and data safety, GSK, Merck, MSD, Roche, Novartis, Sanofi and Vifor, outside the submitted work, Humans, lecture honoraria and travel support from AstraZeneca, outside the submitted, Male, Middle Aged, monitoring/advisory board participation with AstraZeneca,, no potential conflicts of the interest to report., Oxygen Saturation, the submitted work. D. Stolz reports lecture honoraria from AstraZeneca,, University of Basel, Freiwillige Akademische Gesellschaft Basel and Lungitude, with Gebro Pharma, Janssen and MSD, outside the submitted work. J. Rocken reports, work. M.J. Herrmann reports lecture honoraria from Lowenstein Medical, outside.
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