• Respiratory investigation · Sep 2018

    Prevention of hypoxemia during endobronchial ultrasound-guided transbronchial needle aspiration: Usefulness of high-flow nasal cannula.

    • Osamu Takakuwa, Tetsuya Oguri, Takamitsu Asano, Satoshi Fukuda, Yoshihiro Kanemitsu, Takehiro Uemura, Hirotsugu Ohkubo, Masaya Takemura, Ken Maeno, Yutaka Ito, and Akio Niimi.
    • Department of Education and Research Center for Advanced Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467‑8601, Japan. Electronic address: takakuwa@med.nagoya-cu.ac.jp.
    • Respir Investig. 2018 Sep 1; 56 (5): 418-423.

    BackgroundHypoxemia during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is often encountered even in patients without respiratory impairment before the procedure. The aim of this study was to evaluate the efficacy of a high-flow nasal cannula (HFNC) in preventing hypoxemia during EBUS-TBNA.MethodsThe present investigation was designed as a prospective pilot study. Eligible subjects were adults who could undergo EBUS-TBNA under intravenous midazolam sedation. The main exclusion criteria were as follows: age > 80 years with impaired oxygenation and peripheral oxygen saturation (SpO2) < 95% at room air. The primary outcome was the oxygenation level during the procedure. Cutaneous carbon dioxide tension (PcCO2) and complications were evaluated as secondary outcomes. HFNC use was started at an inspired O2 fraction of 30% and was titrated to maintain SpO2 over 90%. The lowest SpO2 values during EBUS-TBNA were retrospectively compared between patients who underwent HFNC and those were given a conventional nasal cannula as a historical control group.ResultsTwelve patients received HFNCs. The mean lowest SpO2 during the procedure was 93%. Although the mean SpO2 tended to decrease in the early stages, it remained over 90% throughout the procedure. The mean highest PcCO2 was 39 mmHg (range, 30-46 mmHg). There were no major complications. In patients who underwent EBUS-TBNA using a conventional nasal cannula, the mean lowest SpO2 was 88%, which was significantly lower than that in the HFNC cases (p = 0.005).ConclusionHFNC could be an effective and safe device for prevention of hypoxemia during EBUS-TBNA.Copyright © 2018 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

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