Roy Avishek, Khanna Puneet, Chowdhury Sumit Roy, Haritha Damarla, Sarkar Soumya
Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Indian J Crit Care Med. 2022 Oct;26(10):1131-1140. doi: 10.5005/jp-journals-10071-24339.
The widespread diagnostic and therapeutic application of bronchoscopy is often associated with complications like desaturation. This systematic review and meta-analysis intend to scrutinize whether the high-flow nasal cannula (HFNC) is advantageous for providing respiratory support during bronchoscopic procedures under sedation, in comparison with other conventional modalities for oxygen therapy.
A thorough screening of electronic databases was done till 31st December 2021 after obtaining registration in PROSPERO (CRD42021245420). Randomized controlled trials (RCT), evaluating the impact of HFNC and standard/any other oxygen-delivery devices during bronchoscopy were included in this meta-analysis.
We retrieved in nine RCTs, with a total of 1306 patients, the application of HFNC during bronchoscopy led to decreased number of desaturation spells [relative risk (RR) 0.34, 95% confidence interval (CI) 0.27-0.44, = 23%], higher nadir value of SpO [Mean difference (MD) 4.30, 95% CI 2.41-6.19, = 96%], and improved PaO from baseline (MD 21.77, 95% CI 2.8-40.74, = 99%), along with similar PaCO values (MD -0.34, 95% CI -1.82 to 1.13, = 58%) just after the procedure. However, apart from desaturation spell, the findings are significantly heterogeneous. In subgroup analysis, HFNC had significantly lesser desaturation spells and better oxygenation than low-flow devices, but in comparison to noninvasive ventilation (NIV) had a lower nadir value of SpO with no other significant difference.
High-flow nasal cannula led to greater oxygenation and prevented desaturation spells more effectively in comparison with low-flow devices like nasal cannula, venturi mask, etc., and may be considered as an alternative to NIV during bronchoscopy in certain high-risk patients.
Roy A, Khanna P, Chowdhury SR, Haritha D, Sarkar S. The Impact of High-flow Nasal Cannula vs Other Oxygen Delivery Devices during Bronchoscopy under Sedation: A Systematic Review and Meta-analyses. Indian J Crit Care Med 2022;26(10):1131-1140.
支气管镜检查在诊断和治疗方面的广泛应用常常伴随着诸如血氧饱和度下降等并发症。本系统评价和荟萃分析旨在探究与其他传统氧疗方式相比，高流量鼻导管（HFNC）在镇静状态下支气管镜检查过程中提供呼吸支持是否具有优势。
在获得PROSPERO注册（CRD42021245420）后，对电子数据库进行了全面检索，截至2021年12月31日。本荟萃分析纳入了评估HFNC与标准/任何其他氧输送设备在支气管镜检查过程中影响的随机对照试验（RCT）。
我们检索到9项RCT，共1306例患者。支气管镜检查期间应用HFNC导致血氧饱和度下降发作次数减少[相对危险度（RR）0.34，95%置信区间（CI）0.27 - 0.44，P<0.00001]，最低SpO₂值更高[平均差（MD）4.30，95%CI 2.41 - 6.19，P<0.00001]，且与基线相比PaO₂改善（MD 21.77，95%CI 2.8 - 40.74，P<0.00001），同时检查刚结束时PaCO₂值相似（MD -0.34，95%CI -1.82至1.13，P = 0.65）。然而，除血氧饱和度下降发作外，研究结果存在显著异质性。亚组分析显示，与低流量设备相比，HFNC的血氧饱和度下降发作明显更少，氧合效果更好，但与无创通气（NIV）相比，SpO₂最低值更低，无其他显著差异。
与鼻导管、文丘里面罩等低流量设备相比，高流量鼻导管能带来更好的氧合效果，并更有效地预防血氧饱和度下降发作，在某些高风险患者的支气管镜检查过程中，可被视为无创通气的替代方法。
Roy A, Khanna P, Chowdhury SR, Haritha D, Sarkar S. 镇静状态下支气管镜检查时高流量鼻导管与其他氧输送设备的影响：一项系统评价和荟萃分析。《印度重症医学杂志》2022；26(10):1131 - 1140。
