Sustained breath-holds in bronchoscopy: a pause worth taking?-a narrative review

Area of Science:

• Pulmonary Medicine
• Interventional Pulmonology
• Respiratory Physiology

Background:

• Advanced diagnostic bronchoscopy enables peripheral pulmonary lesion biopsies.
• Lesion movement during respiration decreases biopsy precision, especially for small nodules.

Purpose of the Study:

• To review the physiological basis, historical context, and early procedural use of apneic oxygenation during breath-hold maneuvers in bronchoscopy.
• To highlight future research priorities for this emerging technique.

Main Methods:

• A narrative review of studies from inception through May 2025.
• Literature search across Ovid MEDLINE, PubMed, EMBASE, and Google Scholar.
• Focus on apneic oxygenation and breath-hold maneuvers in procedural medicine, particularly pulmonary procedures.

Main Results:

• Passive diffusion can maintain adequate oxygen delivery, but carbon dioxide accumulation poses challenges for predicting hypercapnia.
• Apneic oxygenation is established in airway surgery but its application in bronchoscopy is evolving with limited data.
• Future research should prioritize safety and feasibility studies before randomized trials.

Conclusions:

• Breath-hold maneuvers with apneic oxygenation offer a novel strategy to enhance precision in diagnostic bronchoscopy.
• Structured clinical research is essential to determine the safety, tolerability, and effectiveness of this technique for routine practice.