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Editorials |

Prevention and Management of Hypoxemia During Fiberoptic Bronchoscopy

Paul A. Kvale, MD, FCCP
Author and Funding Information

Affiliations: Detroit, MI
 ,  Dr. Kvale is associated wtih the Division of Pulmonary and Critical Care Medicine, Henry Ford Health System.

Correspondence to: Paul A. Kvale, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202-2689; e-mail: pkvale@hfhs.org



Chest. 2002;121(4):1021-1022. doi:10.1378/chest.121.4.1021
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Generally, hypoxemia is very common with diagnostic fiberoptic bronchoscopy. Hypoxemia occurs with insertion of the bronchoscope through the glottis into the trachea, and becomes worse when local anesthetics or saline solution are instilled into the lower airways. BAL is associated with greater levels of oxygen desaturation than when lavage is not done. This has led physicians routinely to monitor oxygen saturation during and after bronchoscopy, and to the nearly universal use of supplemental oxygen to prevent severe hypoxemia during bronchoscopy.12 A more parsimonious approach, providing supplemental oxygen only to those patients who actually do exhibit desaturation, was the subject of a recent report.3 At times, the fall in oxygen saturation can be sufficiently profound or sustained as to require aborting the procedure, or taking some measure to correct it in order to complete what is intended. While the hypoxemia is associated with cardiac arrhythmias in 11 to 40% of patients who undergo fiberoptic bronchoscopy, the cardiac rhythm disturbances are rarely important clinically.45

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