Disclosure(s): No relevant financial relationship(s) to disclose.
First Author: Ricardo Miranda Fliess de Castro, n/a Co-Author: Isabela Lefevre, n/a – n/a, Faculdade de Medicina de Petrópolis Co-Author: Jafar Aljazeeri, MD, FCCP – Doctor, University of Pittsburgh Medical Center Co-Author: hilario de Sousa Francelino, N/A – MD, Estácio de Sá University Campus Iguatu Co-Author: Hamlet Ghukasyan, n/a – n.a, Hospital Francesc de Borja, Gandia, Spain
Introduction: Hypoxemia is a frequent complication during bronchoscopy, and optimal oxygenation strategies remain clinically important. Previous evidence suggests that high-flow nasal cannula (HFNC) may outperform conventional oxygen therapy (COT). We conducted an updated systematic review and meta-analysis to incorporate recent trials and provide a comprehensive assessment of HFNC’s efficacy.
Methods: PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing HFNC with COT in adult patients undergoing bronchoscopy. Outcomes included the incidence of hypoxemia, the lowest SpO₂, procedure duration, patient comfort, and sedation dose. Pooled data were analyzed using a random-effects model, with results reported as risk ratios (RR), mean differences (MD), or standardized mean differences (SMD), as appropriate. Heterogeneity was assessed using the Cochran Q test and I² statistic.
Results: Seventeen RCTs (n=2,727) were included; 1,344 patients (49.2%) received HFNC. HFNC significantly reduced the risk of hypoxemia (RR 0.40; 95% CI 0.28–0.57; p< 0.0001), increased minimum SpO₂ (MD +4.78 percentage points; 95% CI 3.21–6.35; p< 0.0001), and shortened procedure time (MD –0.90 minutes; 95% CI –1.68 to –0.11; p=0.026). There was no significant difference in patient comfort (SMD –0.07; 95% CI –0.25 to 0.11; p=0.46). Sedation requirements were slightly higher in the HFNC group (SMD 0.17; 95% CI 0.04–0.29; p=0.008).
Conclusions: HFNC significantly reduces hypoxemic events, improves oxygenation, and shortens procedure time compared to COT during bronchoscopy. Despite a small increase in anesthetic use, patient comfort was unaffected. These findings support the preferential use of HFNC during bronchoscopy, particularly when minimizing desaturation is a priority.
