High Flow Nasal Oxygen and Low Flow Oxygen Are Equally Effective in Providing Oxygenation During Bronchoscopy Under Conscious Sedation: A Randomised Controlled Trial.

BACKGROUND AND

OBJECTIVE

Oxygen desaturations and hypoxaemia are common during bronchoscopy despite the use of conventional low flow oxygen (LFO). Some researchers suggest high flow nasal oxygen (HFNO) may improve oxygenation in patients undergoing bronchoscopy; however, trials have varied widely in their methodology and patient population. Evidence of use in a broad patient cohort and assessment of other important considerations, including clinician/patient satisfaction, is lacking. We hypothesised that HFNO during bronchoscopy and EBUS would reduce desaturations/hypoxaemia, oxygen titrations, respiratory rate, and cough frequency when compared to LFO. We also explored clinician and patient satisfaction.

METHODS

Participants undergoing diagnostic bronchoscopy or EBUS with conscious sedation were randomised to receive LFO or HFNO. Data was collected via physiological monitoring devices, health records, and clinician/patient questions. The primary outcome was time spent with SpO2 < 90%.

RESULTS

A total of 121 participants were included. There was no difference in oxygenation and desaturations between LFO (n = 61) and HFNO (n = 60) in all procedures. This was also observed within the separate strata of bronchoscopy (n = 75) and EBUS (n = 46). HFNO reduced the respiratory rate in EBUS procedures (p < 0.05). The clinician satisfaction score was higher with HFNO in bronchoscopy procedures (p < 0.05). The requirement for oxygen titrations was lower with HFNO, but this did not reach statistical significance. There was no difference in cough frequency.

CONCLUSION

LFO and HFNO were equally effective in maintaining oxygenation during bronchoscopy and EBUS in our population. HFNO had higher clinician satisfaction during bronchoscopy and may have a physiological advantage during EBUS as demonstrated by a lower respiratory rate.

TRIAL REGISTRATION: ANZCTRN12623001262695.