High flow nasal cannula versus conventional oxygen therapy during bronchoscopy: A systematic review and individual participant data meta-analysis.

In 30 seconds

This systematic review and individual participant data meta-analysis compared high-flow nasal cannula (HFNC) with conventional oxygen therapy (COT) during bronchoscopy in adults. Across 17 randomised controlled trials involving 3,116 patients, HFNC was associated with lower odds of desaturation than COT (OR 0.23, 95% CI 0.15-0.34). It also reduced procedure interruption, escalation of respiratory support, and airway intervention. Individual data from six trials suggested that relative benefit varied with body mass index and baseline respiratory and heart rates, with greater benefit at lower values; flows ≥45 L/min were associated with reduced desaturation risk.

Key findings

• HFNC reduced desaturation versus COT during bronchoscopy (OR 0.23, 95% CI 0.15-0.34).
• HFNC was associated with fewer procedure interruptions (OR 0.36, 95% CI 0.20-0.67), respiratory support escalations (OR 0.25, 95% CI 0.11-0.55), and airway interventions (OR 0.19, 95% CI 0.10-0.36).
• In individual data from six trials, treatment effects varied with body mass index and baseline respiratory and heart rates, with greater relative benefit at lower values.
• HFNC flows ≥45 L/min were associated with lower desaturation risk (OR 0.28, 95% CI 0.12-0.65).

Why it matters

Bronchoscopy can be complicated by desaturation and interruptions. This synthesis indicates that HFNC may reduce these events compared with conventional oxygen, while also lowering the need for respiratory support escalation and airway intervention. The exploratory treatment-modifier findings may help frame questions about which patients benefit most, but require confirmation, particularly in higher-risk populations.

What to keep in mind

Individual participant data were available from only six of the 17 included trials; the authors call for further studies in higher-risk patients.