Prospective Experience of High-flow Nasal Oxygen During Bronchoscopy in 182 Patients: A Feasibility Study.

BACKGROUND: High-flow nasal oxygen (HFNO) has recently gained popularity during administration of anesthesia in a variety of circumstances, including apneic oxygenation. Fully qualified anesthesiologists provide sedation for our outpatient bronchoscopy service. We adopted this therapy to assess its efficacy providing optimal conditions (using a variety of sedation regimens) for patient and bronchoscopist. METHODS: We aimed to conduct a prospective feasibility evaluation. We collected data from all patients undergoing outpatient bronchoscopy or endobronchial ultrasound with anesthesiologist administered sedation over 21 months. Demographic data, high-flow settings, sedation techniques, and oxygen saturations (SpO2) were collected for each patient. Feedback from the bronchoscopists and anesthesiologists was recorded. Failure of the technique was defined as abandonment of the procedure or prolonged desaturation not amenable to basic airway maneuvers or increase in oxygen flow rate. RESULTS: All 182 patients underwent satisfactory bronchoscopy or endobronchial ultrasound. Mean age was 63 (±14) years. High-flow rate varied from 10 to 70 L/min. All patients received a remifentanil infusion and 175 (96%) had a propofol infusion. SpO2 before the procedure were lower (96%) than the highest saturation during the procedure with high flow (100%, P<0.0001). Ten patients transiently desaturated to <89%. Some had their flow rates increased, others required a transient jaw thrust, but all patient's saturations rapidly returned to satisfactory levels. One patient became apneic during sedation. Respiration returned after pausing the sedation and oxygen SpO2 remained above 93% throughout. All bronchoscopists and anesthesiologists were happy with the use of HFNO. CONCLUSION: HFNO has been shown to be effective in the outpatient bronchoscopy setting. Further evaluation regarding flow rates and levels of sedation is required.

Evaluating Implementation of the Updated Care Considerations for Duchenne Muscular Dystrophy.

Care Considerations for Duchenne Muscular Dystrophy were published in 2010. However, little is known about the extent to which these considerations were implemented after publication. With this article, we provide direction on evaluating the uptake of the 2018 Duchenne Muscular Dystrophy Care Considerations. We identify key elements of care and present suggestions for their use in evaluation and research.