Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
Respir Res. 2022 Jun 2;23(1):144. doi: 10.1186/s12931-022-02063-0.
Flexible bronchoscopy is widely used to diagnose and treat various respiratory diseases. However, caution is warranted for post-bronchoscopy adverse events. Although desaturation frequently occurs during bronchoscopy, its clinical impact and the optimal oxygen saturation level during the procedure remain unclear. This study aimed to investigate whether the percutaneous oxygen saturation (SpO) level during bronchoscopy is associated with the development of post-bronchoscopy respiratory adverse events.
In this single-center retrospective cohort study conducted from March 2020 to February 2021, 569 patients were classified into high or low oxygen saturation groups based on the SpO level during bronchoscopy. The primary outcome was post-bronchoscopy respiratory adverse events, and secondary outcomes were other post-bronchoscopy adverse events and clinical outcomes.
Among 569 patients, 458 and 111 patients were classified into the high oxygen saturation (SpO > 96%) and low oxygen saturation (SpO ≤ 94%) groups, respectively. After propensity score matching, the low oxygen saturation group had more post-bronchoscopy respiratory and febrile adverse events than the high oxygen saturation group. In the multivariable regression analysis, low SpO level during bronchoscopy was an independent risk factor for post-bronchoscopy respiratory adverse events (odds ratio = 3.16 [95% confidence interval 1.37-7.30]). In the low oxygen saturation group, the high-risk subgroups for post-bronchoscopy respiratory adverse events were the elderly, women, current smokers, and patients with chronic obstructive pulmonary disease or acute decompensated heart failure before bronchoscopy. There was no significant difference in the length of hospital stay, intensive care unit admission, or mortality between the high and low oxygen saturation groups.
Close monitoring is recommended for patients with SpO ≤ 94% during bronchoscopy due to the increased risk of respiratory adverse events after the procedure.
纤维支气管镜广泛用于诊断和治疗各种呼吸系统疾病。然而，支气管镜检查后不良事件需要谨慎。尽管支气管镜检查过程中经常会出现低氧血症，但低氧血症的临床影响和最佳氧饱和度水平仍不清楚。本研究旨在探讨支气管镜检查过程中经皮氧饱和度（SpO）水平是否与支气管镜检查后呼吸不良事件的发生有关。
本研究为 2020 年 3 月至 2021 年 2 月期间进行的单中心回顾性队列研究，根据支气管镜检查时的 SpO 水平将 569 例患者分为高氧饱和度组（SpO>96%）和低氧饱和度组（SpO≤94%）。主要结局为支气管镜检查后呼吸不良事件，次要结局为其他支气管镜检查后不良事件和临床结局。
569 例患者中，458 例和 111 例患者分别归入高氧饱和度（SpO>96%）和低氧饱和度（SpO≤94%）组。经倾向评分匹配后，低氧饱和度组的支气管镜检查后呼吸和发热不良事件多于高氧饱和度组。多变量回归分析显示，支气管镜检查时低 SpO 水平是支气管镜检查后呼吸不良事件的独立危险因素（比值比=3.16[95%置信区间 1.37-7.30]）。在低氧饱和度组中，支气管镜检查后呼吸不良事件的高危亚组为老年人、女性、现吸烟者，以及支气管镜检查前患有慢性阻塞性肺疾病或急性失代偿性心力衰竭的患者。高氧饱和度组和低氧饱和度组之间的住院时间、入住重症监护病房和死亡率无显著差异。
由于支气管镜检查后发生呼吸不良事件的风险增加，对于 SpO≤94%的患者建议密切监测。
