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HFNC reduces oxygen desaturation and procedure interruptions during bronchoscopy in high-risk patientsHigh-flow oxygen during bronchoscopy reduces breathing problems in high-risk patients

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Key Takeaway
Consider HFNC to reduce hypoxemia risk during bronchoscopy in high-risk patients, noting moderate evidence certainty.

This meta-analysis of randomized controlled trials evaluated high-flow nasal cannula (HFNC) versus conventional oxygen therapy (COT) for preventing intraprocedural hypoxemia and complications during bronchoscopy. The analysis included 1,054 high-risk patients, typically with underlying conditions like COPD or obesity. The primary outcome was not explicitly stated, but key secondary outcomes included oxygen desaturation, procedure interruptions, lowest SpO2, and procedure duration.

HFNC significantly reduced the odds of oxygen desaturation (OR 0.14, 95% CI 0.08-0.27; P < 0.00001) and procedure interruptions (OR 0.18, 95% CI 0.09-0.34; P < 0.00001) compared to COT. HFNC also increased the lowest recorded SpO2 by a mean difference of 5.89% (95% CI 3.19-8.58; P < 0.0001). There was no significant difference in procedure duration between the groups. Safety and tolerability data were not reported.

Key limitations include heterogeneity among studies, partly attributable to varying definitions of hypoxemia, and an inability to blind personnel to the intervention. The certainty of evidence is noted as moderate for most outcomes. The analysis supports the use of HFNC to improve procedural safety in this vulnerable population, but the findings are specific to high-risk patients and absolute risk reductions are not reported.

Researchers analyzed data from multiple clinical trials to see if a high-flow nasal cannula (HFNC) is better than conventional oxygen therapy at preventing breathing problems during a bronchoscopy procedure. The review focused on over 1,000 high-risk patients, such as those with chronic lung disease (COPD) or obesity, who are more likely to have complications during this type of exam.

The main finding was that high-flow oxygen was linked to much better outcomes. Patients using HFNC were significantly less likely to have dangerous drops in blood oxygen (a condition called desaturation) and had fewer procedure interruptions. Their lowest oxygen levels during the procedure were also higher on average. There was no significant difference in how long the procedure took.

It's important to be cautious because the studies in this review had some limitations. For example, they used slightly different definitions for what counted as a breathing problem, and the medical staff knew which oxygen treatment patients were getting, which can influence results. The review did not report on safety concerns or side effects. This evidence supports using HFNC to make bronchoscopy safer for vulnerable patients, but it is based on a combined analysis of existing trials, not a single new study.

What this means for you:
High-flow oxygen shows promise for safer bronchoscopies in high-risk patients, but study limitations mean more research is still needed.

Study Details

Study typeMeta analysis
Sample sizen = 1,054
EvidenceLevel 1
PublishedJan 2026
View Original Abstract ↓
BACKGROUND: Patients with underlying conditions such as chronic obstructive pulmonary disease (COPD) or obesity are at high risk for hypoxemia during bronchoscopy. Whether a high-flow nasal cannula (HFNC) is superior to conventional oxygen therapy (COT) for preventing this complication is well-studied, but a focused synthesis in high-risk populations is needed. OBJECTIVES: To compare the efficacy of HFNC versus COT in preventing intraprocedural hypoxemia and other complications in high-risk patients undergoing bronchoscopy. METHODS: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for RCTs up to October 2025. Methodological quality was assessed using the Cochrane Risk of Bias tool, and data were pooled with RevMan 5.3. RESULTS: Five RCTs (1054 patients) were included. Compared to COT, HFNC significantly reduced oxygen desaturation (OR 0.14, 95 % CI 0.08-0.27; P < 0.00001; I = 62 %) and procedure interruptions (OR 0.18, 95 % CI 0.09-0.34; P < 0.00001; I = 21 %). HFNC also increased the lowest SpO (MD = 5.89 %, 95 % CI 3.19-8.58; P < 0.0001; I = 90 %). No significant difference was found in procedure duration. Sensitivity analyses confirmed the robustness of the primary findings, and the certainty of evidence was moderate for most outcomes. DISCUSSION: HFNC significantly reduces the risk of hypoxemia and procedure interruptions compared with COT in high-risk patients undergoing bronchoscopy, supporting its use to improve procedural safety in this vulnerable population. Limitations include heterogeneity partly attributable to varying hypoxemia definitions and an inability to blind personnel. REGISTRATION: PROSPERO CRD420251174924.
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