Divisions of Critical Care, Pulmonary and Sleep Medicine, McGovern Medical School at the University of Texas Health Sciences Center, Houston, TX, USA.
Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Clin Respir J. 2021 Jun;15(6):670-675. doi: 10.1111/crj.13342. Epub 2021 Mar 11.
The safety of bronchoscopy in obese patients and those with obstructive sleep apnea (OSA) is unclear. Our objective was to evaluate the incidence of complications during bronchoscopy under moderate sedation in obese patients and to assess the impact of OSA, body mass index (BMI), and duration of the procedure.
We performed a retrospective study in adult patients undergoing bronchoscopy from January 2010 to August 2019. All patients with BMI > 30 kg/m were included. Logistic regression analyses were used to identify the factors associated with all-complications and respiratory complications.
A total of 345 obese patients were identified. The average BMI in our cohort was 35.3 ± 5.1 kg/m . During the pre-procedure risk assessment, 165 (47.8%) patients were labelled as "suspected OSA." The most common doses of sedation given during the bronchoscopies were fentanyl 50 mcg (34.5%) and midazolam 3 mg (33.6%). The incidence of major complications was 0.6% and minor complications were 41.2%. Minor respiratory (22.9%) and cardiac (26.4%) complications were common. No deaths occurred due to bronchoscopy. Factors that were associated with increased respiratory complications were female gender, suspected OSA, and bronchoscopy duration 20-30 minutes and bronchoscopy duration greater than 1 hour.
Bronchoscopy under moderate sedation performed in obese patients is safe; however, increased risk may exist with females, increased procedure time, and suspected OSA.
肥胖患者和阻塞性睡眠呼吸暂停（OSA）患者行支气管镜检查的安全性尚不清楚。我们的目的是评估中度镇静下肥胖患者行支气管镜检查的并发症发生率，并评估 OSA、体重指数（BMI）和操作时间的影响。
我们对 2010 年 1 月至 2019 年 8 月期间行支气管镜检查的成年患者进行了回顾性研究。所有 BMI＞30 kg/m 的患者均被纳入。采用逻辑回归分析来确定与所有并发症和呼吸并发症相关的因素。
共纳入 345 例肥胖患者。我们队列的平均 BMI 为 35.3±5.1 kg/m。在术前风险评估中，165 例（47.8%）患者被标记为“疑似 OSA”。支气管镜检查中最常用的镇静药物剂量为芬太尼 50 mcg（34.5%）和咪达唑仑 3 mg（33.6%）。主要并发症发生率为 0.6%，小并发症发生率为 41.2%。常见的小并发症为呼吸（22.9%）和心脏（26.4%）并发症。无因支气管镜检查导致的死亡。与呼吸并发症增加相关的因素包括女性、疑似 OSA 以及 20-30 分钟和大于 1 小时的支气管镜操作时间。
在肥胖患者中进行的中度镇静下支气管镜检查是安全的；然而，女性、操作时间延长和疑似 OSA 可能会增加风险。
