Qin Hao, Li Jie, Wang Jun, Yang Yu-Guang, Jing Guo-Qiang, Chen Rong-Zhang, Tan Wei, Zhang Yong-Qi, Li Tian, Yang Jun-Ci, Dai Bing, Wang Qin, Jiao Yang, Xia Yang, Huang Hai-Dong, Li Qiang, Dong Yu-Chao, Bai Chong, Zhang Wei
Department of Respiratory and Critical Care Medicine.
Center of Critical Care Medicine.
Ann Am Thorac Soc. 2025 Jul;22(7):1018-1026. doi: 10.1513/AnnalsATS.202410-1109OC.
Despite the increasing use of high-flow nasal cannula (HFNC) oxygen therapy during endoscopy examination, its impact on high-risk patients remains uncertain. We aimed to compare HFNC and conventional oxygen therapy (COT) during nasal bronchoscopy in patients at high risk for desaturation (morbid obesity, narrow trachea, or baseline hypoxemia and/or hypercapnia). In this multicenter randomized controlled trial, patients scheduled for bronchoscopy and presenting with any high-risk factors were randomly assigned to receive HFNC or COT after providing written consent. Vital signs, pulse oximetry (Sp), and transcutaneous carbon dioxide were continuously monitored. The occurrence of desaturation (Sp ⩽ 90% lasted >10 s), frequency of examination interruption, and treatment escalation were compared between groups. Of 148 initially enrolled patients, 6 withdrew, leaving 72 and 70 in the HFNC and COT groups, respectively. Most of the patients had airway stenosis. HFNC significantly reduced desaturation occurrence during bronchoscopy (34.7% vs. 61.4%; = 0.016), with fewer instances of examination interruption (26.4% vs. 58.6%; < 0.001) and less frequent treatment escalation (30.6% vs. 57.1%; = 0.001). During the examination, the lowest Sp was higher with HFNC (94% [interquartile range, 87-98%] vs. 87.5% [79-93%]; = 0.001), whereas the highest transcutaneous carbon dioxide was lower (64.6 [56.8-70.1] vs. 68.3 [62.3-77.0] mm Hg; = 0.04). No significant differences were observed regarding the time to the first desaturation, bronchoscopy withdrawal, durations of desaturation and bronchoscopy examination, or occurrence of other adverse events between groups. In a high-risk population with predominant airway stenosis, HFNC significantly reduced desaturation occurrence, examination interruption, and treatment escalation during nasal bronchoscopy examination in high risk patients. Clinical trial registered with www.chictr.org.cn (ChiCTR2100055038).
尽管在内镜检查期间高流量鼻导管（HFNC）氧疗的使用越来越多，但其对高危患者的影响仍不确定。我们旨在比较在饱和度降低高危患者（病态肥胖、气管狭窄或基线低氧血症和/或高碳酸血症）进行鼻支气管镜检查时HFNC和传统氧疗（COT）的效果。在这项多中心随机对照试验中，计划进行支气管镜检查且有任何高危因素的患者在提供书面同意后被随机分配接受HFNC或COT。持续监测生命体征、脉搏血氧饱和度（Sp）和经皮二氧化碳。比较两组间饱和度降低（Sp⩽90%持续>10秒）的发生率、检查中断频率和治疗升级情况。在最初纳入的148例患者中，6例退出，HFNC组和COT组分别剩下72例和70例。大多数患者存在气道狭窄。HFNC显著降低了支气管镜检查期间饱和度降低的发生率（34.7%对61.4%；P = 0.016），检查中断情况较少（26.4%对58.6%；P < 0.001），治疗升级频率较低（30.6%对57.1%；P = 0.001）。检查期间，HFNC组的最低Sp较高（94%[四分位间距，87 - 98%]对87.5%[79 - 93%]；P = 0.001），而最高经皮二氧化碳较低（64.6[56.8 - 70.1]对68.3[62.3 - 77.0]mmHg；P = 0.04）。两组间首次出现饱和度降低的时间、支气管镜检查结束、饱和度降低持续时间和支气管镜检查持续时间或其他不良事件的发生率未观察到显著差异。在以气道狭窄为主的高危人群中，HFNC显著降低了高危患者鼻支气管镜检查期间饱和度降低的发生率、检查中断和治疗升级情况。临床试验已在www.chictr.org.cn注册（ChiCTR2100055038）。
