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At least 235 records · Page 13Linked to original sources

PubMed2001

Do all patients require supplemental oxygen during flexible bronchoscopy?

STUDY OBJECTIVES: Some respiratory units routinely administer supplemental oxygen to all patients during flexible bronchoscopy, but other units give oxygen only to those who desaturate (arterial oxygen saturation [SaO(2)], < 90%). We performed a study to examine both the requirement for supplemental oxygen and the effect of IV midazolam therapy on oxygenation during flexible bronchoscopy for patients with a known FEV(1). DESIGN: Data on the SaO(2) of patients during flexible bronchoscopy were collected prospectively for all procedures performed in our respiratory unit for the period 1992 to 1997. RESULTS: There were 1,051 flexible bronchoscopy procedures performed in which the patient had a known FEV(1) and was not receiving supplemental oxygen before the procedure. Supplemental oxygen was commenced during or immediately after the procedure in 151 cases (14.4%), while a further 101 cases (9.6%) had momentary desaturation (ie, < 20 s) not requiring oxygen therapy. The lower the FEV(1), the greater the risk of significant desaturation and the need for supplemental oxygen (p < 0.0001) [supplemental O(2) therapy was administered in 35% of cases if FEV(1) < 1.0 L, in 14% of cases if FEV(1) was 1.0 to 1.5 L, and in 7% of cases if FEV(1) > 1.5 L]. The use of low-to-moderate doses of midazolam as sedation did not affect the probability of the occurrence of significant desaturation (p = 0.204). CONCLUSIONS: This study supports guidelines that suggest that all patients should be monitored by pulse oximetry during flexible bronchoscopy. Desaturation may occur at any FEV(1) level even without sedation. The majority of our patients did not require routine oxygen supplementation, especially the group with an FEV(1) above 1 L.

Bronchoscopy↗

PubMed2006

Acute phase reaction in healthy volunteers after bronchoscopy with lavage.

STUDY OBJECTIVES: Bronchoscopy with BAL is being used increasingly in the investigation of acute and chronic lung inflammation. The scope of the acute phase response induced by the procedure is not fully evaluated. The purpose of the study is to characterize the acute phase response induced by bronchoscopy with BAL. DESIGN: Observational study. SETTING: A human study research facility. PARTICIPANTS: Normal nonsmoking volunteers. INTERVENTION: A total of 28 subjects were recruited. Under local anesthesia, the subjects underwent bronchoscopy with a videofiberoptic bronchoscope. One subsegment of the lingular segment of the left upper lobe and the right middle lobe were lavaged each with 170 to 270 mL of sterile normal saline solution. MEASUREMENTS AND RESULTS: CBC count, serum levels of indexes of iron homeostasis, fibrinogen, C-reactive protein (CRP), and plasma mediators related to neutrophil migration and endothelial cell activation, including interleukin (IL)-8, angiotensin converting enzyme (ACE), soluble intercellular adhesion molecule (sICAM)-1, and nitrite/nitrate, were measured. Measurements of these plasma markers were done immediately before, immediately after, and 24 h after bronchoscopy. Changes in acute phase response were detected primarily at 24 h after the procedure. WBCs, primarily neutrophils, increased by approximately 50%. Fibrinogen increased by 25% while CRP increased by more than sevenfold. Serum ferritin increased by 25% while serum iron, total iron-binding capacity, and transferrin saturation decreased, indicating dysregulation of iron homeostasis. There were no changes in IL-8, ACE, sICAM-1, or nitrite/nitrate plasma levels. CONCLUSIONS: Bronchoscopy with BAL induces a variety of acute phase responses that includes peripheral neutrophilia, dysregulation of iron homeostasis, and increased levels of fibrinogen and CRP. Human research that employs BAL may need to consider the biological effects induced by the procedure-related acute phase response.

Acute-Phase Proteins↗

PubMed1975

Management of arterial hypoxemia induced by fiberoptic bronchoscopy.

Twenty patients undergoing fiberoptic bronchoscopy (FOB) (bronchofiberscopy) were studied with serial arterial blood gas analyses. Ten patients were managed using a 40 percent Venturi mask with a 2-cm opening cut out for the FOB; there were ten other patients, with this opening modified by a thin rubber diaphragm with a slit for insertion of the FOB. Both masks decreased the extent of hypoxemia after bronchoscopy, but the mask with the diaphragm provided significantly higher PaO2 values. A significantly higher mean FIO2 was found at the carina in the group using the diaphragm-modified mask. This study suggests that declines in PaO2 after bronchoscopy can be avoided in most patients undergoing diagnostic FOB by using a diaphragm-modified 40 percent Venturi mask during and after the procedure. However, patients with a PaO2 below 60 mm Hg before bronchoscopy may require other measure to avoid potentially hazardous degrees of hypoxemia after bronchoscopy.

Blood Gas Analysis↗

PubMed1991

Pulmonary surveillance using bronchoscopy and bronchoalveolar lavage during high-dose antineoplastic therapy.

Pulmonary failure is a major contributor to morbidity and mortality during marrow aplasia following high-dose antineoplastic therapy. For this reason, we initiated a pulmonary surveillance program for patients undergoing high-dose chemotherapy for leukemia or bone marrow transplantation. As part of this program, bronchoscopy with BAL was performed prior to therapy and at the onset of granulocytopenia. Thirty-three of the first 57 patients managed in this program developed some evidence of pulmonary complications. Twelve patients died in aplasia; all had pulmonary failure. Forty patients had clinically significant abnormalities on the bronchoscopy before treatment including 12 of 19 patients who had normal findings on chest x-ray films, physical examination, and pulmonary function testing, and no fever. Twenty-seven patients had clinically significant abnormal bronchoscopy or BAL at the onset of granulocytopenia. Thirteen patients required additional bronchoscopy. No patient required an open lung biopsy. Pulmonary surveillance using bronchoscopy with BAL is useful in the detection of pulmonary disease prior to the initiation of and following high-dose antineoplastic therapy.

Adult↗

PubMedDate not supplied

Bronchodilators in bronchoscopy-induced airflow limitation in allergen-sensitized cats.

This study investigated the effect of bronchoscopy and bronchoalveolar lavage (BAL) on respiratory function, determined by barometric whole-body plethysmography (BWBP), of healthy and allergen-sensitized cats. Furthermore, the efficacy of inhaled bronchodilators in preventing changes in respiratory function was determined. For test 1, 18 healthy experimental cats were investigated on day 1 by BWBP. On day 2, the cats underwent BWBP after sedation (medetomidine), after anesthesia induction (propofol), and after bronchoscopy and BAL. Enhanced pause (Penh) was significantly increased after bronchoscopy and BAL (1.64 +/- 0.17 versus 1.23 +/- 0.07, P < .05). For test 2, 6 cats were sensitized to ovalbumin (OVA), 6 cats were sensitized to Ascaris suum (AS), and 6 cats served as controls. On day 0, OVA- and AS-sensitized cats underwent an inhaled allergen challenge, whereas controls were exposed to saline. On days 1 and 2, the same protocol as described for test 1 was repeated. Post-BAL Penh of the AS-sensitized cats was significantly higher than at test 1 (2.28 +/- 0.22 versus 1.69 +/- 0.33, P < .05) and was correlated with BAL fluid neutrophil count (r = 0.55, P < .05). During tests 3, 4, and 5, the same protocol as used for test 2 was applied to each cat group, with the animals being randomly treated before sedation with inhaled salbutamol (200 microg), ipratropium bromide (40 microg), or a combination of both (200 + 40 microg). Post-BAL Penh of the AS-sensitized group was significantly decreased after the salbutamol + ipratropium bromide treatment (1.56 +/- 0.18 versus 2.28 +/- 0.22, P < .05). This study suggests that bronchoscopy and BAL induce airflow limitation in cats, which is more severe in the presence of lower airway inflammation. Inhaled salbutamol + ipratropium bromide reduce BAL-induced bronchoconstriction in AS-challenged cats and might be recommended as preventive treatment of asthmatic cats undergoing bronchoscopy.

Albuterol↗

PubMed1988

Photodynamic laser therapy to alleviate complete bronchial obstruction: comparison of CT and bronchoscopy to predict outcome.

Photodynamic laser therapy is used in the palliation of advanced lung cancer. To minimize the complications of this form of therapy, physicians must evaluate correctly the extent of extraluminal disease. We undertook a study to compare CT and bronchoscopy in the evaluation of extent of disease before laser therapy in 20 patients with complete bronchial obstruction. The relative contribution of intraluminal and extraluminal tumor to the obstruction and its influence on response to therapy was assessed by using both techniques. Adequate response was defined as greater than or equal to 50% relief of the obstruction on bronchoscopy performed within 1 week of therapy and by any improvement of the postobstructive atelectasis and consolidation on follow-up chest radiographs. Nine patients had predominately intraluminal tumor on both CT and bronchoscopy before laser therapy. Eight of these had a bronchoscopic response and radiographic improvement after therapy. Ten patients had predominately extrinsic compression by tumor on CT. Of these, only two had a bronchoscopic response and none had radiographic improvement after treatment. The differences in bronchoscopic and radiographic response between the two groups were significant (p less than .01). In the 10 patients with predominately extraluminal tumor on CT, bronchoscopy agreed with CT in suggesting mainly extrinsic compression in five, but it incorrectly suggested mainly intraluminal tumor in the remaining five. In one patient with a left upper-lobe tumor, the relative intra- and extraluminal components could not be assessed on CT. We conclude that in complete bronchial obstruction, CT is superior to bronchoscopy in evaluating the extent of extrinsic compression by tumor. The presence of predominately extraluminal tumor compression on CT correlates with a poor response to laser therapy.

Adult↗

PubMed1997

Navigational aids for real-time virtual bronchoscopy.

OBJECTIVE: Virtual bronchoscopy is a recently described technique for performing simulated bronchoscopy using data obtained from thin-section CT scans of the airways. Although the detail visible during virtual bronchoscopy can be striking, the lack of global context and physical cues can lead to disorientation for the radiologist, especially during real-time "fly-throughs." We investigated the use of seven software tools (coordinate axes, global maps, trail markers, cross-references to standard two-dimensional projections, rear-view windows, collision avoidance, and stereoscopic displays) that are navigational aids to overcome such disorientation. CONCLUSION: The navigational aids performed satisfactorily on virtual bronchoscopy studies from 21 patients. A frame rate of one to seven frames per second, depending on the complexity of the bronchial model, could be attained. Several of the aids worked best when used selectively or when updated frequently but not continuously. Navigational aids are potentially useful for guiding radiologists who do virtual bronchoscopy studies. Such aids are general tools that may be applicable to other types of virtual endoscopy.

Adult↗

PubMed2001

Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis.

OBJECTIVE: We wanted to investigate the utility of performing fiberoptic bronchoscopy before bronchial artery embolization in patients with massive hemoptysis. MATERIALS AND METHODS: We retrospectively reviewed the cases of all patients with hemoptysis who had presented at either of two local hospitals, one county hospital and one community hospital, between 1988 and 2000 and who had undergone fiberoptic bronchoscopy before bronchial arteriography. All data were abstracted using a standardized coding form, and radiographs were independently reviewed by two of the authors. RESULTS: Twenty-nine patients meeting the inclusion criteria were identified; one patient was excluded because of missing radiographs. The remaining 28 patients consisted of 19 men and nine women, with an average age of 54.6 years (age range, 16-91 years). The clinically determined diagnoses of their symptoms were tuberculous bronchiectasis (n = 14; 50.0%); bronchogenic carcinoma (n = 4; 14.3%); active tuberculosis (n = 2; 7.1%); nontuberculous bronchiectasis (n = 2; 7.1%); active coccidioidomycosis, pancreaticobronchial fistula, arteriovenous malformation, and tetralogy of fallot (n =1 each; 3.6% each); and unknown cause (n = 2; 7.1%). The bleeding site determined through bronchoscopy was consistent with that determined through radiographs in 23 patients (82.1%); all had either unilateral disease (n = 15), bilateral disease with unilateral cavities (n = 5), or a preponderance of disease on one side (n = 3). Bronchoscopy was an essential tool in determining the bleeding site in only three patients (10.7%), all of whom had bronchiectasis without localizing features visible on chest radiographs. In the remaining two patients (7.1%), bronchoscopic findings were indeterminate, but radiographs were helpful. CONCLUSION: Fiberoptic bronchoscopy before bronchial artery embolization is unnecessary in patients with hemoptysis of known causation if the site of bleeding can be determined from radiographs and no bronchoscopic airways management is needed.

Adolescent↗

PubMed2005

Safety, diagnostic yield, and therapeutic implications of flexible bronchoscopy in patients with febrile neutropenia and pulmonary infiltrates.

OBJECTIVE: To evaluate the safety, diagnostic yield, and therapeutic implications of flexible bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy in patients with febrile neutropenia and pulmonary infiltrates. PATIENTS AND METHODS: We retrospectively reviewed the medical records of all patients with neutropenic fever and pulmonary infiltrates evaluated by flexible bronchoscopy and BAL between January and December 2002 at the Mayo Clinic in Rochester, Minn. Appropriate demographic, clinical, microbiological, and histological data and procedure-related complications were summarized. Therapeutic decisions implemented based on Information obtained by bronchoscopy, and 28-day mortality were determined. RESULTS: Thirty-five patients with febrile neutropenia and associated pulmonary infiltrates were identified. Flexible bronchoscopy, including 35 BALs and 9 transbronchial biopsies, was performed safely (3 complications). The diagnostic yield of BAL was 49%. Sputum analysis was underused (only 34%) but complementary to BAL. The combined diagnostic yield of BAL and sputum analysis was 63%. Transbronchial biopsy provided additional information to BAL and sputum analysis In only 1 patient and did not substantially increase the combined diagnostic yield. The most common diagnoses identified were fungal pneumonias (15/35 [43%]) and diffuse alveolar hemorrhage (5/35 [14%]). Bronchoscopic findings resulted in management changes in 51% of patients. The 28-day mortality rate was 26% and was highest in patients who required mechanical ventilatory assistance before bronchoscopy. CONCLUSION: The favorable safety record, good diagnostic yield, and frequent therapeutic implications support the routine use of BAL for the evaluation of pulmonary inflitrates in neutropenic patients. Bronchoalveolar lavage should be combined with the analysis of several sputum specimens. Transbronchial biopsy did only change the management of 1 patient.

Anti-Bacterial Agents↗

PubMed2000

Bronchoscopy, indications, safety and complications.

OBJECTIVE: To review the safety, indications, complications of flexible fiberoptic bronchoscopies performed at university teaching hospital, and to correlate the bronchoscopic findings with radiology, histology, and history of smoking. METHODS: A total of 124 consecutive flexible fiberoptic bronchoscopies were reviewed in the last 3 years. A special form that contains personal data, indications, premedications, route of insertion, bronchoscopic findings, and complications in subjects-undergone bronchoscopy was completed. RESULTS: A suspicion of pulmonary tuberculosis (31%), lung mass (19%) and hemoptysis (18%) were the most common indications. Hypoxemia (14%) during procedure and pneumothorax post procedure were the most common complications. Mortality rate was 0%. For 57% of subjects who had histology, lung cancer (44%), and tuberculosis (15.5%) were commonly found. Lung cancer (72%) and tuberculosis granuloma (18%) were mainly responsible for narrow segments during bronchoscopy. A radiological tumor like mass was found histopathologically to be as lung cancer in 86% and as tuberculous granuloma in 5%. About 84% of lung cancer patients were either smokers (57%) or ex-smokers (27%) as compared to only 35% in smokers and 13% in ex-smokers in patients without lung cancer, P-value<0.01. CONCLUSION: Flexible fiberoptic bronchoscopy can be performed safely whenever indicated. Complications occurred were minor and self limiting. Appropriate preparation, and close supervision and adherence to the protocol were essential for a successful and safe procedure.

Bronchial Diseases↗

PubMed2000

CT virtual bronchoscopy: imaging method and clinical application.

OBJECTIVE: To evaluate the imaging method and clinical application of CT virtual bronchoscopy (CTVB). METHODS: Fifty-two patients with bronchial and pulmonary diseases were studied with CTVB. All patients underwent fiberoptic bronchoscopy and patients with lung cancers were confirmed pathologically. Lung cancer of center type was found in 46 patients, postoperative lung cancer in 4, tracheal adenoidcystic carcinoma in 1, and bronchial diverticulum in 1. CTVB was performed using Navigator Smooth software on the workstation (Advantage Windows 3.1, GE Medical Systems). Source images included slice thickness of 3 mm or 5 mm, pitch of 1.0 or 1.5, 1.0 mm or 2.0 mm interval (overlap more than 60%) reconstruction. RESULTS: CTVB could reveal vividly the tracheobronchial lumens, the cartilage rings, the carina and the left and right main bronchi, down to the fourth order of bronchial orifices, mimicing fiberoptic bronchoscopy. Among 46 patients with lung cancers of center type, fiberoptic bronchoscopy showed the masses in 45 patients and CTVB displayed the masses in 42. The sensitivity of CTVB was 93.3% and its accuracy was 93.5% (chi 2 = 1.33, 0.10 < P < 0.25). The tumors appeared as masses or nodules, causing bronchial stenosis (n = 35) or occlusion (n = 7). The bronchial rings near the masses were blurred, smooth or absent in contrast to the findings of fiberoptic endoscopy. Postoperative bronchial stump (n = 4) appeared to be smooth. Bronchial diverticulum exhibited a local concavity on CTVB and local protrusion on surface shadow display (SSD). CTVB could pass through the stenotic bronchi and detect the occlusive bronchi from the distal end. CONCLUSIONS: The sensitivity of CTVB in detecting bronchial masses was higher than that of fiberoptic bronchoscopy. Combined with multiplanar reconstruction (MPR) and CTVB can demonstrate the extraluminal extension of tumors. As a noninvasive examining method, however, CTVB is limited to observe mucosal abnormalities and to obtain histologic samples.

Adult↗

PubMed2001

Role of bronchoscopy in massive hemoptysis.

Airway hemorrhage is a potentially rapidly fatal condition. Death may occur within minutes from asphyxiation before control can be achieved. The primary prognostic factors are the rate of bleeding and the underlying cardiopulmonary status of the patient. Bronchoscopy is central in management, but the goals differ, depending on circumstances. In stable patients who have minimal hemoptysis, bronchoscopy can diagnose the cause specifically and be used as the primary treatment modality. In the setting of massive or life-threatening bleeding, bronchoscopy primarily is performed to maintain ventilation and to direct endobronchial blockade. Although flexible bronchoscopy is an acceptable mode initially, there should be no delay in performing rigid bronchoscopy when it becomes apparent that bleeding is too vigorous to permit [figure: see text] successful airway exploration with the smaller flexible instrument. Once isolation of bleeding has been achieved, the choice must be made between embolization, surgical resection, or both of these procedures.

Acute Disease↗

PubMed2003

Research applications of bronchoscopy.

The technique of flexible bronchoscopy creates unique research opportunities to investigate the underlying mechanisms of respiratory disease in children, by sampling directly from the airway. Bronchoscopy is, however, invasive and the ethics of performing this type of procedure for research purposes must be considered carefully at the outset. This article discusses the research applications of bronchoscopy in children, focusing on the ethical and safety issues, the types of procedure that can be performed and their application to the investigation of specific diseases. Acceptance of the use of bronchoscopy as a research tool is increasing. Future work should focus on the comparison of invasive and non-invasive techniques, the use of bronchoscopy in longitudinal and interventional studies and the development of new, highly sensitive techniques to allow us to study disease pathogenesis in greater detail. Collaboration between centres should be encouraged to maximise the use of samples obtained.

Bronchoscopy↗

PubMed1992

Bronchoscopy and tuberculostearic acid assay in the diagnosis of sputum smear-negative pulmonary tuberculosis: a prospective study with the addition of transbronchial biopsy.

A prospective study of the efficacy of bronchoscopy and tuberculostearic acid assay in the diagnosis of sputum smear-negative pulmonary tuberculosis (TB) was carried out in 39 patients with symptoms and radiographic changes suggestive of active pulmonary TB. The diagnosis of TB was confirmed in 15 patients, probable TB was diagnosed in eight and 16 patients did not have TB. An early diagnosis of TB was made by bronchoscopy in six patients (40 per cent). Culture of sputum obtained before bronchoscopy was positive in nine patients (60 per cent) while combined with bronchoscopy specimens, a positive mycobacterial culture was obtained in 12 patients (80 per cent). Mycobacteria were cultured from transbronchial biopsy specimens from five patients (33 per cent) but none of these was exclusively positive. Histological examination of transbronchial biopsy tissue was diagnostic of TB in four patients and it was the exclusive means of early diagnosis in two. Transbronchial biopsy also provided an alternative diagnosis in four other patients. Tuberculostearic acid assay had a sensitivity of 0.40 in bronchial aspirate, 0.80 in bronchoalveolar lavage fluid, and 0.27 in transbronchial biopsy specimens: the combined result was 0.87. In nine patients with pulmonary TB in whom an early diagnosis could not be made, the tuberculostearic acid assay was positive in seven (78 per cent). We conclude that bronchoscopy with bronchoalveolar lavage and transbronchial biopsy is helpful in providing early diagnosis and positive culture results. Assay of tuberculostearic acid in bronchoalveolar lavage fluid is a useful adjunct to early diagnosis. However, mycobacterial culture and assay of tuberculostearic acid in transbronchial biopsy specimens have little diagnostic value.

Adolescent↗

PubMed2004

Advances in bronchoscopy--new and upcoming bronchoscopic methods at the dawn of the 21st century.

The last decade has seen the increasing application of bronchoscopic methods such as transbronchial needle aspiration in the staging of lung cancer as well as in the diagnosis of peripheral lung cancer, balloon dilatation using flexible bronchoscopy, development of new tracheobronchial stents to manage central airway obstruction, autofluorescence bronchoscopy for the early diagnosis of lung cancer and pediatric flexible bronchoscopy. There is also a better understanding in the mechanisms and management of hypoxemia during bronchoscopy such as upper airway obstruction. Recent developments include direct endobronchial ultrasound to increase the yield of transbronchial needle aspiration, high magnification bronchoscopy to assist in the diagnosis of early lung cancer and bronchoscopic lung volume reduction to gain the effects lung volume reduction surgery without the need for surgery in patients with severe emphysema. In this article the new and upcoming bronchoscopic techniques are discussed, which we believe will find a broader clinical application in the near future to manage patients in a better way.

Bronchoscopy↗

PubMed2004

[Neonatal bronchoscopy: a retrospective analysis of 67 cases and a review of their indications].

The availability of newer, more sophisticated and versatile bronchoscopes has expanded the spectrum and scope of the indications for bronchoscopy in the newborn infant both for diagnostic and therapeutic purposes. The aim of this study was to carry out a retrospective analysis of the bronchoscopies performed on newborn infants, and to review the indications of this procedure in this age group. Sixty-three patients were submitted to 67 bronchoscopies in a period of 13 years, allowing the diagnosis of 45 anomalies and malformations of the tracheo-bronchial tree, and the performance of 24 bronchoalveolar lavages. In six cases, endoscopic removal of secretions helped to resolve resistant atelectasia, while in another case, with esophageal atresia, intra-operative definition of the fistula tract was possible through catheterisation of the fistula with the bronchoscope. The flexible bronchoscope was preferred for diagnosis by direct visualisation, and the rigid bronchoscope for some diagnostic and therapeutic procedures. Stridor, unexplained cyanosis, hemoptysis, persistent or recurrent pulmonary images, difficulties in the intubation or extubation, and persistent disturbances in ventilation are among the main indications for bronchoscopy in the newborn infant. Bronchoscopy also allows the performance of subsidiary techniques, such as bronchoalveolar lavage, biopsy and laser therapy.

Bronchoscopy↗

PubMed1991

Importance of fiberoptic bronchoscopy before and during chemotherapy for small cell carcinoma of the lung in the evaluation of complete remission.

The aim of our study was to evaluate the role of fiberoptic bronchoscopy both in diagnosing patients with small cell lung carcinoma and in assessing complete remission following combination chemotherapy. Although there were 90 patients in this study, 33 patients received the complete restaging procedure. Initially at diagnosis, all lesions seen through the bronchoscopy were localized to central bronchi in 22 patients. In the other 10 patients there was either bronchial distortion or abnormal mucosal appearance. In the last one no endoscopic lesion was assessed. Following combination chemotherapy complete remission in 12 patients was assessed by comparing the findings at repeat fiberoptic bronchoscopy with those of chest radiology. In this study, three (25%) of 12 patients with negative radiological patterns were still affected by the tumor at fiberoptic bronchoscopy. The higher reliability of fiberoptic bronchoscopy than that of standard chest X-ray is emphasized.

Aged↗

PubMedDate not supplied

Predictors of oxygen desaturation in patients undergoing diagnostic bronchoscopy.

BACKGROUND: Oxygen desaturation is not uncommon during bronchoscopy. We sought to identify factors predictive of desaturation during flexible bronchoscopy. METHODS: Over eight months, we enrolled 137 randomly selected patients who were undergoing fiberoptic bronchoscopy at our medical center. The patients' oxygen saturation was monitored on their arrival and during the procedure by finger pulse oximetry. Desaturation was defined as an overall saturation nadir of < 90% or an episode of decreased saturation of 5% from the baseline regardless of whether the patient was receiving supplemental oxygen. RESULTS: The need for oxygen supplementation before the procedure was predictive of a higher rate of desaturation episodes (73.9% vs. 50%, p = 0.036). Although all interventional procedures or their complications can cause desaturation, the specific type of procedure was the most important predictor of desaturation (lavage, 88.9%; washing, 43.8%; brushing, 15.2%; biopsy, 10%). A low peak expiratory flow rate before the procedure seemed to be predictive of a high desaturation rate in patients undergoing lavage or washing during bronchoscopy. CONCLUSION: Our study suggested that age, sex and baseline oxygen saturation were not predictors of desaturation. We should be reminded of the possibility of desaturation during every procedure, especially in patients who need supplemental oxygen before bronchoscopy.

Adult↗