Association between intraprocedural oxygen administration and postprocedural pneumothorax after ct-guided...

Pneumothorax is the most common complication of computed tomography (CT)-guided transthoracic lung biopsy (TLB). Whether supplemental oxygen administered during the procedure before pneumothorax detection is associated with postprocedural pneumothorax remains unclear. This study evaluated the association between documented intraprocedural oxygen administration and postprocedural pneumothorax.

This single-center retrospective cohort study included 442 consecutive patients who underwent CT-guided TLB between January 2022 and June 2025. Patients were grouped according to documented oxygen administration during the biopsy and before pneumothorax detection. Oxygen administration was non-standardized, and the exact dose and timing could not be reliably determined. Clinical, imaging, and procedural variables were evaluated. The primary outcome was postprocedural pneumothorax. Multivariable logistic regression analysis was performed to identify factors independently associated with pneumothorax.

Intraprocedural oxygen administration was documented in 118 patients (26.7%), whereas 324 patients (73.3%) received no intraprocedural oxygen. Pneumothorax occurred in 141 patients (31.9%). The pneumothorax rate did not differ significantly between the oxygen and no-oxygen groups [36/118 (30.5%) vs. 105/324 (32.4%); absolute risk difference, - 1.9% points; 95% CI, - 11.6 to 7.8; p = 0.705]. No statistically significant association was identified between documented intraprocedural oxygen administration and postprocedural pneumothorax in the univariable analysis (OR, 0.916; 95% CI, 0.581-1.444; p = 0.705) or after multivariable adjustment (adjusted OR, 0.807; 95% CI, 0.492-1.323; p = 0.395). Non-pleural-based lesion location and CT-detected emphysema were independently associated with pneumothorax, whereas the association with lower subcutaneous tissue thickness should be considered exploratory. Pulmonary hemorrhage and pneumothorax-related intervention rates did not differ significantly between the groups.

In this retrospective cohort, no statistically significant association was identified between documented intraprocedural oxygen administration and postprocedural pneumothorax after CT-guided TLB. This finding does not exclude a preventive effect, which should be evaluated in prospective studies using standardized oxygen protocols.

Not applicable.