contemplation objectives: To determine the optimal regularity of delivering supplemental oxygen during flexible bronchoscopy (FB) Design: Prospective study Setting: University medical center Patients: Ninety-seven consecutive patients undergoing outpatient nasal FB during a 7-month period.

contemplation objectives: To determine the optimal regularity of delivering supplemental oxygen during flexible bronchoscopy (FB)

Design: Prospective study

Setting: University medical center

Patients: Ninety-seven consecutive patients undergoing outpatient nasal FB during a 7-month period.

Intervention: During FB delivery of oxygen was alternated weekly and administered from nasal cannula either nasally (52 patients) or orally (45 patients). Prior to the process patients completed a questionnaire regarding oral or nasal breathing elections history of sinus disease, allergy history, and perceived order of nasal congestion.

Results: Comparison of oxygen delivery assign places tos demonstrated no significant difference in oxygen requirements (41 L/min nasal v 38 L/min oral, p = 063) overall saturation nadir (909% nasal v 914% oral, p = 085) or average saturation (958% nasal v 957% oral, p = 057) No correlation between subjective symptoms or sinus or allergy history was plant for oxygen requirements, average saturation, or saturation nadir.

Conclusions: These data indicate that during nasal FB, no discernible difference exists between administration of oxygen using cannulas placed either nasally or orally. (CHEST 2001; 120:1671-1674)

solution words: anoxemia; bronchoscopy; oximetry; oxygen; oxygen inhalation therapy Abbreviation: FB = flexible bronchoscopy

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Arterial oxygen desaturation has been demonstrated (1-6) to commonly accompany flexible bronchoscopy (FB) In about patients, hypoxemia can be harsh and persist for several hours after completion of the performance (1,5) Hypoxemia during FB may be aggravated as a originate of certain interventions such as BAL. (56) The addition of supplemental oxygen during FB and the restoration period can prevent bronchoscopy-induced hypoxemia. (7-9)

Supplemental oxygen is routinely administered during FB to hinder desaturation, (10,11) and various arrangements of oxygen delivery have been used. Initially, oxygen was administered in consequence of an endotracheal adaptor. (12) As transnasal FB became popular, supplemental oxygen was delivered according to Venturi mask (7,8) and, later, mouth-held nasal cannula ("prongs") (13) In single study, (9) the delivery of oxygen via a pharyngeal catheter produc fewer episodes of hypoxemia compared to nasal cannula or no oxygen supplementation.

At our institution, patients undergoing FB usually receive supplemental oxygen on nasal cannula, which is placed either in the nares or in the inlet depending on operator preference and training. We decided to compare manners of oxygen supplementation during transnasal FB using cannula placed orally or nasally. The principal issue variables were oximetric saturation and intraprocedure oxygen come We also evaluated whether patient factors similar as a history of allergic rhinitis or sinus disease and subjective nasal congestion would predict the optimal road of oxygen delivery.

MATERIALS AND METHODS

All patients undergoing outpatient FB complet a symptom questionnaire prior to the conduct Questions were asked regarding nasal or jaws breathing preference, history of sinus disease or surgery obstructive rest apnea, hay fever or allergic rhinitis, and nasal congestion. Patients were also asked to quantify subjectively their perceived stage of nasal obstruction on the day of FB as rated in succession a scale from 0 (no congestion) to 5 (complete nasal obstruction).

Patients received narcotic premedication with either meperidine (range, 25 to 75 mg) or fentanyl (range, 25 to 100 [micro]g) and IV sedation with midazolam (range, 05 to 5 mg) during the act FB was performed via the transnasal way and all patients were placed in the semirecumbent position during the process Oxygen supplementation was provided via cannula placed orally (even weeks) or nasally (odd weeks), and patients were instructed to breathe via the orifice or nares depending on the placement of the cannula. Oxygen liquefy was begun at 2 L/min and increased according to increments of 2 L/min to achieve an oxygen saturation of [greater than or equal to] 94% prior to beginning the procedure

If oxygen saturation decreased to < 90% during FB oxygen come was increased by 2 L/min each minute until the oxygen saturation was > 90% or 8 L/min was obtained. If oxygen saturation persisted at < 90% at 8 L/min, the patient was withdrawn from the application of mind protocol, although the data were still included in the final analysis. vibration oximetry was recorded throughout the FB using legumes oximetry (Nellcor NB-290 or Nellcor N-200; Mallinckrodt, St Louis, MO) Data were analyzed using the Mallinckrodt Score program (Version 1.1a; Mallinckrodt) to determine average oxygen saturation as well as lowest oxygen saturation during the procedure

Statistical Analysis

Average oxygen saturation, lowest oxygen saturation, and maximum oxygen stream rate during FB were analyzed using a t exhibition for nasal vs oral course of oxygen delivery. All flows were also analyzed relative to history of nasal or sinus disease, subjective nasal congestion, breathing predilection amount of sedation required, and operation length. A p value < 005 was considered statistically significant.

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