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

Innovations in advanced diagnostic bronchoscopy have transformed our ability to biopsy peripheral pulmonary lesions. Lesion movement throughout the respiratory cycle can reduce biopsy precision, particularly when targeting small nodules. To eliminate this, breath-hold (BH) maneuvers using apneic oxygenation have recently gained traction despite minimal data on their use during bronchoscopy. This narrative review explores the physiological basis, historical context, and early procedural use of apneic oxygenation in bronchoscopy, highlighting future research priorities.

We reviewed studies published from inception through May 2025 using Ovid MEDLINE, PubMed, EMBASE, and Google Scholar. We focused on literature evaluating apneic oxygenation and BH maneuvers in procedural medicine, focusing on its historical development, physiology, feasibility, and its application in pulmonary procedures.

Prior studies have demonstrated that adequate oxygen delivery can be maintained through passive diffusion, supporting tissue perfusion in the absence of ventilation. However, carbon dioxide accumulates along a nonlinear trajectory, making the prediction of hypercapnia and respiratory acidosis challenging. Although well established in airway surgery, the application of apneic oxygenation in bronchoscopy is still evolving, with limited published data to guide its use. Future research should adopt a stepwise approach, beginning with safety and feasibility studies before progressing to comparative randomized trials.

Sustained BH maneuvers are a novel strategy to increase procedural precision in advanced diagnostic bronchoscopy. Structured clinical research will be critical to defining its safety, tolerability, effectiveness, and role in routine clinical practice before widespread implementation.