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VOLUME 26 , ISSUE 10 ( October, 2022 ) > List of Articles

SYSTEMATIC REVIEW

The Impact of High-flow Nasal Cannula vs Other Oxygen Delivery Devices during Bronchoscopy under Sedation: A Systematic Review and Meta-analyses

Damarla Haritha, Soumya Sarkar

Keywords : Bronchoscopy, High-flow nasal cannula, Noninvasive ventilation

Citation Information : Haritha D, Sarkar S. The Impact of High-flow Nasal Cannula vs Other Oxygen Delivery Devices during Bronchoscopy under Sedation: A Systematic Review and Meta-analyses. Indian J Crit Care Med 2022; 26 (10):1131-1140.

DOI: 10.5005/jp-journals-10071-24339

License: CC BY-NC 4.0

Published Online: 30-09-2022

Copyright Statement:  Copyright © 2022; The Author(s).


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.


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  1. Shinagawa N. A review of existing and new methods of bronchoscopic diagnosis of lung cancer. Respir Investig 2019;57(1):3–8. DOI: 10.1016/j.resinv.2018.08.004.
  2. Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: Accredited by NICE. Thorax 2013;68 (Suppl 1): i1–i44. DOI: 10.1136/thoraxjnl-2013-203618.
  3. Kvale PA. Prevention and management of hypoxemia during fiber-optic bronchoscopy. Chest 2002;121(4):1021–1022. DOI: 10.1378/chest.121.4.1021.
  4. Jones AM, O'Driscoll R. Do all patients require supplemental oxygen during flexible bronchoscopy? Chest 2001;119(6):1906–1909. DOI: 10.1378/chest.119.6.1906.
  5. Jin F, Mu D, Chu D, Fu E, Xie Y, Liu T. Severe complications of bronchoscopy.Respiration 2008;76(4):429–433. DOI: 10.1159/000 151656.
  6. Stahl DL, Richard KM, Papadimos TJ. Complications of bronchoscopy: A concise synopsis. Int J Crit Illn Inj Sci 2015;5(3):189–195. DOI: 10.4103/2229-5151.164995.
  7. Milman N, Faurschou P, Grode G, Jørgensen A. Pulse oximetry during fibreoptic bronchoscopy in local anaesthesia: Frequency of hypoxaemia and effect of oxygen supplementation. Respiration 1994;61(6):342–347. DOI: 10.1159/000196366.
  8. Patout M, Caillard C, Jolly G, El Husseini K, Le Brun M, De Marchi M, et al. Noninvasive ventilation (NIV) related adverse events. Eur Respir J 2018;52 (Suppl 62):PA2378. DOI: 10.1183/13993003.congress-2018.PA2378.
  9. Singh A, Khanna P, Sarkar S. High-flow nasal cannula, a boon or a bane for COVID-19 patients? An evidence-based review. Curr Anesthesiol Rep 2021;1–6. DOI: 10.1007/s40140-021-00439-4.
  10. Sampsonas F, Karamouzos V, Karampitsakos T, Papaioannou O, Katsaras M, Lagadinou M, et al. High-flow vs. low-flow nasal cannula in reducing hypoxemic events during bronchoscopic procedures: A systematic review and meta-analysis. Front Med (Lausanne) 2022;9:815799. DOI: 10.3389/fmed.2022.815799.
  11. Su CL, Chiang LL, Tam KW, Chen TT, Hu MC. High-flow nasal cannula for reducing hypoxemic events in patients undergoing bronchoscopy: A systematic review and meta-analysis of randomized trials. PLoS One 2021;16(12):e0260716. DOI: 10.1371/journal.pone.0260716.
  12. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009;6(7):e1000097. DOI: 10.1371/journal.pmed.1000097.
  13. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l4898. DOI: 10.1136/bmj.l4898.
  14. Norris SL, Meerpohl JJ, Akl EA, Schünemann HJ, Gartlehner G, Chen Y, et al. The skills and experience of GRADE methodologists can be assessed with a simple tool. J Clin Epidemiol 2016;79:150–158.e1. DOI: 10.1016/j.jclinepi.2016.07.001.
  15. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011;64(4):383–394. DOI: 10.1016/j.jclinepi.2010.04.026.
  16. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011;64(4):401–406. DOI: 10.1016/j.jclinepi.2010.07.015.
  17. Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, et al. GRADE guidelines: 4. Rating the quality of evidence–study limitations (risk of bias). J Clin Epidemiol 2011;64(4):407–415. DOI: 10.1016/j.jclinepi.2010.07.017.
  18. Guyatt GH, Oxman AD, Montori V, Vist G, Kunz R, Brozek J, et al. GRADE guidelines: 5. Rating the quality of evidence—publication bias. J Clin Epidemiol 2011;64(12):1277–1282. DOI: 10.1016/j.jclinepi.2011.01.011.
  19. Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence—imprecision. J Clin Epidemiol 2011;64(12):1283–1293. DOI: 10.1016/j.jclinepi.2011.01.012.
  20. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 7. Rating the quality of evidence—inconsistency. J Clin Epidemiol 2011;64(12):1294–1302. DOI: 10.1016/j.jclinepi.2011.03.017.
  21. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 8. Rating the quality of evidence—indirectness. J Clin Epidemiol 2011;64(12):1303–1310. DOI: 10.1016/j.jclinepi. 2011.04.014.
  22. Guyatt GH, Oxman AD, Sultan S, Glasziou P, Akl EA, Alonso-Coello P, et al. GRADE guidelines: 9. Rating up the quality of evidence. J Clin Epidemiol 2011;64(12):1311–1316. DOI: 10.1016/j.jclinepi.2011.06.004.
  23. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 2019;10:ED000142. DOI: 10.1002/14651858.ED000142.
  24. Douglas N, Ng I, Nazeem F, Lee K, Mezzavia P, Krieser R, et al. A randomised controlled trial comparing high-flow nasal oxygen with standard management for conscious sedation during bronchoscopy. Anaesthesia 2018;73(2):169–176. DOI: 10.1111/anae.14156.
  25. Irfan M, Ahmed M, Breen D. Assessment of high flow nasal cannula oxygenation in endobronchial ultrasound bronchoscopy: A randomized controlled trial. J Bronchology Interv Pulmonol 2021; 28(2):130–137. DOI: 10.1097/LBR.0000000000000719.
  26. Longhini F, Pelaia C, Garofalo E, Bruni A, Placida R, Iaquinta C, et al. High-flow nasal cannula oxygen therapy for outpatients undergoing flexible bronchoscopy: A randomised controlled trial. Thorax 2022;77 (1):58–64. DOI: 10.1136/thoraxjnl-2021-217116.
  27. Lucangelo U, Vassallo FG, Marras E, Ferluga M, Beziza E, Comuzzi L, et al. High-flow nasal interface improves oxygenation in patients undergoing bronchoscopy. Crit Care Res Pract 2012;2012:506382. DOI: 10.1155/2012/506382.
  28. Ben-Menachem E, McKenzie J, O'Sullivan C, Havryk AP. High-flow nasal oxygen versus standard oxygen during flexible bronchoscopy in lung transplant patients: A randomized controlled trial. J Bronchology Interv Pulmonol 2020;27(4):259–265. DOI: 10.1097/LBR.0000000000000670.
  29. Saksitthichok B, Petnak T, So-ngern A, Boonsarngsuk V. A prospective randomized comparative study of high-flow nasal cannula oxygen and non-invasive ventilation in hypoxemic patients undergoing diagnostic flexible bronchoscopy. J Thorac Dis 2019;11(5):1929–1939. DOI: 10.21037/jtd.2019.05.02.
  30. Simon M, Braune S, Frings D, Wiontzek AK, Klose H, Kluge S. High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy—a prospective randomised trial. Crit Care 2014; 18(6):712. DOI: 10.1186/s13054-014-0712-9.
  31. Yilmazel Ucar E, Araz Ö, Kerget B, Akgun M, Saglam L. Comparison of high-flow and conventional nasal cannula oxygen in patients undergoing endobronchial. Intern Med J 2021;51(11):1935–1939. DOI: 10.1111/imj.15001.
  32. Wang R, Li HC, Li XY, Tang X, Chu HW, Yuan X, et al. Modified high-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients undergoing bronchoscopy: A randomized clinical trial. BMC Pulm Med 2021;21(1):367. DOI: 10.1186/s12890-021-01744-8.
  33. Zhao H, Wang H, Sun F, Lyu S, An Y. High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: A systematic review and meta-analysis. Crit Care 2017;21(1):184. DOI: 10.1186/s13054-017-1760-8.
  34. Leong LB, Ming NW, Feng LW. High flow nasal cannula oxygen versus noninvasive ventilation in adult acute respiratory failure: A systematic review of randomized-controlled trials. Eur J Emerg Med 2019;26(1):9–18. DOI: 10.1097/MEJ.0000000000000557.
  35. Frat JP, Ragot S, Girault C, Perbet S, Prat G, Boulain T, et al. Effect of non-invasive oxygenation strategies in immunocompromised patients with severe acute respiratory failure: A post-hoc analysis of a randomised trial. Lancet Respir Med 2016;4(8):646–652. DOI: 10.1016/S2213-2600 (16)30093-5.
  36. Frat J-P, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015;372(23):2185–2196. DOI: 10.1056/NEJMoa1503326.
  37. Antonelli M. The feasibility and safety of fiberoptic bronchoscopy during noninvasive ventilation in patients with established acute lung injury: Another small brick in the wall. Crit Care 2011;15(5):191. DOI: 10.1186/cc10342.
  38. Li J, Jing G, and Scott JB. Year in review 2019: High-flow nasal cannula oxygen therapy for adult subjects. Respir Care 2020;65(4):545–557. DOI: 10.4187/respcare.07663.
  39. Service JA, Bain JS, Gardner CP, McNarry AF. Prospective experience of high-flow nasal oxygen during bronchoscopy in 182 patients: A feasibility study. J Bronchology Interv Pulmonol 2019;26(1):66–70. DOI: 10.1097/LBR.0000000000000533.
  40. Chung SM, Choi JW, Lee YS, Choi JH, Oh JY, Min KH, et al. Clinical effectiveness of high-flow nasal cannula in hypoxaemic patients during bronchoscopic procedures. Tuberc Respir Dis (Seoul) 2019; 82(1):81–85. DOI: 10.4046/trd.2017.0104.
  41. Parke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth 2009;103(6):886–890. DOI: 10.1093/bja/aep280.
  42. Zayed Y, Banifadel M, Barbarawi M, Kheiri B, Chahine A, Rashdan L, et al. Noninvasive oxygenation strategies in immunocompromised patients with acute hypoxemic respiratory failure: A pairwise and network meta-analysis of randomized controlled trials. J Intensive Care Med 2020;35(11):1216–1225. DOI: 10.1177/0885066619844713.
  43. Maitra S, Som A, Bhattacharjee S, Arora MK, Baidya DK. Comparison of high-flow nasal oxygen therapy with conventional oxygen therapy and noninvasive ventilation in adult patients with acute hypoxemic respiratory failure: A meta-analysis and systematic review. J Crit Care 2016;35:138–144. DOI: 10.1016/j.jcrc.2016.05.013.
  44. La Combe B, Messika J, Labbé V, Razazi K, Maitre B, Sztrymf B, et al. High-flow nasal oxygen for bronchoalveolar lavage in acute respiratory failure patients. Eur Respir J 2016;47(4):1283–1286. DOI: 10.1183/13993003.01883-2015.
  45. Diab S, Fraser JF. Maintaining oxygenation successfully with high flow nasal cannula during diagnostic bronchoscopy on a postoperative lung transplant patient in the intensive care. Case Rep Crit Care 2014;2014:1–3. DOI: 10.1155/2014/198262.
  46. Li J, Scott JB, Lee JH. Defining the optimal role of high-flow nasal cannula in pediatric procedural sedation. Pediatr Pulmonol 2020;55 (12):3225–3227. DOI: 10.1002/ppul.25105.
  47. Thille AW, Muller G, Gacouin A, Coudroy R, Decavele M, Sonneville R, et al. Effect of postextubation high-flow nasal oxygen with noninvasive ventilation vs high-flow nasal oxygen alone on reintubation among patients at high risk of extubation failure: A randomized clinical trial. JAMA 2019;322(15):1465–1475. DOI: 10.1001/jama.2019.14901.
  48. Shen Y, Cai G, Yan J. Effect of high flow nasal cannula therapy may be modified by PaO2/FiO2 ratio in acute hypoxemic respiratory failure. Intensive Care Med 2019;45(8):1169–1170. DOI: 10.1007/s00134-019-05671-5.
  49. Li J, Jing GQ, Scott JB. Year in review 2019 HFNC oxygen therapy for adult patients. Respir Care 2020;65(4):545–557. DOI: 10.4187/respcare.07663.
  50. Roca O, Messika J, Caralt B, García-de-Acilu M, Sztrymf B, Ricard JD, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. J Crit Care 2016;35:200–205. DOI: 10.1016/j.jcrc.2016.05.022.
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