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Evidence on Non-Invasive Respiratory Support During Flexible Bronchoscopy: A Narrative Review.
María Hidalgo Sánchez1, Manel Luján2, Sergio Alcolea Batres1
1Pulmonology Department, Hospital Universitario La Paz-Cantoblanco-Carlos III, Faculty of Medicine, Universidad Autónoma de Madrid (UAM), IdiPAZ, 28046 Madrid, Spain.
Non-invasive respiratory support during flexible bronchoscopy (FB) effectively prevents oxygen desaturation. High-flow therapy (HFT) suits mild cases, while CPAP or NIV is better for severe respiratory compromise.
Area of Science:
- Pulmonology
- Critical Care Medicine
- Respiratory Physiology
Background:
- Flexible bronchoscopy (FB) is a common procedure for pulmonary diseases.
- FB can worsen hypoxemia due to airway resistance and alveolar issues.
- Patients undergoing FB often have pre-existing gas exchange impairment.
Purpose of the Study:
- To evaluate non-invasive respiratory support strategies for preventing oxygen desaturation during FB.
- To assess the efficacy of different non-invasive oxygen methods in reducing complications.
Main Methods:
- Systematic review and meta-analysis of studies from 2000-2024.
- Included adult patients undergoing FB with non-invasive oxygen support.
- Analyzed 12 high-quality studies (RCTs, prospective cohorts).
Main Results:
- High-flow therapy (HFT) improved oxygenation and reduced interruptions compared to conventional oxygen therapy (COT).
- CPAP and NIV provided superior support for patients with severe respiratory or cardiac compromise.
- HFT was particularly effective in moderate hypoxemia and high-risk patients (obesity, OSA).
Conclusions:
- Individualize non-invasive respiratory support based on patient risk and procedure complexity.
- HFT is recommended for mild-to-moderate cases; CPAP/NIV for severe cases.
- Further multicenter RCTs are needed to establish formal guidelines for respiratory support during FB.
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