Communications to the Editor |

Changes in Oxygen Saturation in Patients Undergoing Fiberoptic Bronchoscopy FREE TO VIEW

Pınar Yıldız, MD; Akif Özgül, MD; Veysel Yılmaz, MD
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Affiliations: Yedikule Chest Disease and Chest Surgery Hospital Istanbul, Turkey,  Hope Hospital Salford, United Kingdom

Correspondence to: Pınar Yıldız, MD, Kartaltepe Mahallesi, Ömür Sokak, No. 20/8, Bakırköy, Istanbul, Turkey; e-mail: pinary70@hotmail.com

Chest. 2002;121(3):1007-1008. doi:10.1378/chest.121.3.1007
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To the Editor:

We read with great interest the article by Jones and O’Driscoll that appeared in CHEST (June 2001).1 They reported that supplemental oxygen treatment during fiberoptic bronchoscopy (FOB) was required in 151 of the patients (14.4%), and nearly half of the patients who need supplemental oxygen therapy had FEV1 levels <1 L in a large-scale study. We have recently investigated the predicting factors on the changes in saturation during FOB in a prospective study. In our unit, based in a 500-bed teaching hospital in Turkey, supplemental oxygen is not administered routinely to all patients during FOB. Forty-four patients (33 male and 11 female patients; mean ± SD age, 51 ± 17 years) who did not require oxygen treatment at least 2 weeks before FOB were included. Bronchoscopies were performed transnasally, and low-to-moderate doses of IM midazolam and atropine were used as premedication in all patients.

Oxygen saturation was monitored during the procedure with pulse oximetry (PO) [model 305; Palco Laboratories; Santa Cruz, CA], and arterial blood gas levels were measured before and after FOB. For predicting the lowest saturation value during FOB, age, gender, primary disease, presence of pleural effusion and/or atelectasia, time of FOB procedure, and basal saturation values were taken as independent variables.

No difference in saturation values was found between arterial blood gas levels and PO analysis both before and after FOB. This finding suggests monitoring of saturation with PO during FOB is a noninvasive and reliable method. Saturation values (mean ± SD) were significantly decreased after FOB (from 96.5 ± 1.0% to 91.6 ± 3.6%, p < 0.001), and desaturation (arterial oxygen saturation < 90%) was detected in 22 of the patients (50%) during the procedure.

In linear regression analysis for predicting the lowest saturation values (model r = 0.68, p = 0.008), duration of FOB (p = 0.008) was found to be the only independent variable. However, no association was found with other variables.

In conclusion, monitoring by PO should be performed in all patients during FOB. Supplemental oxygen therapy might be required in patients for whom the duration of the FOB procedure was longer.

Jones, AM, O’Driscoll, R (2001) Do all patients require supplemental oxygen during flexible bronchoscopy?.Chest119,1906-1909. [PubMed]
To the Editor:

Pulse oximetry is an established method for the detection of hypoxemia.1 Yildiz et al have monitored patients during bronchoscopy by pulse oximetry and measured arterial blood gas levels before and after the procedure. Their findings support pulse oximetry as a valid and reliable tool for monitoring saturation during flexible bronchoscopy. The authors comment that half (n = 22) the patients studied had an episode of desaturation during the procedure, although they did not state if the episodes were transient or prolonged, and the number of patients who required supplemental oxygen is not given.

Their finding of an association between duration of the procedure and lower patient oxygen saturation values is of interest, but unlikely to influence clinical practice for bronchoscopists because oxygen is likely to be administered to hypoxic patients whether the problem arises early or late in the procedure. Furthermore, for most cases, it is impossible to prospectively predict the duration of the procedure.

Supplemental oxygen is not mandatory for all patients, but it can be commenced during or after flexible bronchoscopy for any patient who has a prolonged episode of desaturation. We agree with Yildiz et al that it is essential to monitor all patients for the development of hypoxemia during and immediately after flexible bronchoscopy, as a fall in oxygen saturation may occur for any patient, regardless of duration of procedure, FEV1 level, or use of sedation.

Severinghaus, JW, Kelleher, FJ Recent developments in pulse oximetry.Anaesthesiology1992;76,1018-1038. [CrossRef]




Jones, AM, O’Driscoll, R (2001) Do all patients require supplemental oxygen during flexible bronchoscopy?.Chest119,1906-1909. [PubMed]
Severinghaus, JW, Kelleher, FJ Recent developments in pulse oximetry.Anaesthesiology1992;76,1018-1038. [CrossRef]
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