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- Title
The Impact of High-flow Nasal Cannula vs Other Oxygen Delivery Devices during Bronchoscopy under Sedation: A Systematic Review and Meta-analyses.
- Authors
Roy, Avishek; Khanna, Puneet; Chowdhury, Sumit Roy; Haritha, Damarla; Sarkar, Soumya
- Abstract
Background: The widespread diagnostic and therapeutic application of bronchoscopy is often associated with complications like desaturation. This systematic review and meta-analysis intend to scrutinize whether the high-flow nasal cannula (HFNC) is advantageous for providing respiratory support during bronchoscopic procedures under sedation, in comparison with other conventional modalities for oxygen therapy. Materials and methods: A thorough screening of electronic databases was done till 31st December 2021 after obtaining registration in PROSPERO (CRD42021245420). Randomized controlled trials (RCT), evaluating the impact of HFNC and standard/any other oxygen-delivery devices during bronchoscopy were included in this meta-analysis. Results: We retrieved in nine RCTs, with a total of 1306 patients, the application of HFNC during bronchoscopy led to decreased number of desaturation spells [relative risk (RR) 0.34, 95% confidence interval (CI) 0.27-0.44, I² = 23%], higher nadir value of SpO2 [Mean difference (MD) 4.30, 95% CI 2.41-6.19, I² = 96%], and improved PaO2 from baseline (MD 21.77, 95% CI 2.8-40.74, I² = 99%), along with similar PaCO2 values (MD -0.34, 95% CI -1.82 to 1.13, I² = 58%) just after the procedure. However, apart from desaturation spell, the findings are significantly heterogeneous. In subgroup analysis, HFNC had significantly lesser desaturation spells and better oxygenation than low-flow devices, but in comparison to noninvasive ventilation (NIV) had a lower nadir value of SpO2 with no other significant difference. Conclusion: High-flow nasal cannula led to greater oxygenation and prevented desaturation spells more effectively in comparison with low-flow devices like nasal cannula, venturi mask, etc., and may be considered as an alternative to NIV during bronchoscopy in certain high-risk patients.
- Subjects
RELATIVE medical risk; MEDICAL masks; NASAL cannula; ANESTHESIA; META-analysis; CONFIDENCE intervals; SYSTEMATIC reviews; OXYGEN saturation; ARTIFICIAL respiration; COMPARATIVE studies; OXYGEN therapy; DESCRIPTIVE statistics; REACTIVE oxygen species; BRONCHOSCOPY; OXYGEN in the body
- Publication
Indian Journal of Critical Care Medicine, 2022, Vol 26, Issue 10, p1131
- ISSN
0972-5229
- Publication type
Article
- DOI
10.5005/jp-journals-10071-24339