Clinical observation of fiberoptic bronchoscopy in patients undergoing continuous positive airway pressure and high-flow humidification cannula oxygen therapy

doi:10.3877/cma.j.issn.1674-6880.2020.03.007

Abstract

Abstract:

Objective

To investigate the clinical effect of fiberoptic bronchoscopy in patients undergoing continuous positive airway pressure (CPAP) and high-flow humidification cannula oxygen therapy (HFHCO).

Methods

Twenty-six patients with indwelling artificial airway who were treated by fiberoptic bronchoscopy from December 2018 to July 2019 were enrolled. According to the operation times of fiberoptic bronchoscopy, they were divided into a CPAP group (32 times) and a HFHCO group (32 times). The heart rate, respiratory rate, mean arterial pressure, and peripheral arterial blood saturation (SaO₂) before and during fiberoptic bronchoscopy and pH value, arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), and pulse oxygen saturation (SpO₂) before and after operation were compared between the two groups. The adverse effects of fiberoptic bronchoscopy were recorded in both groups.

Results

During operation, the heart rate [(121 ± 3) beats / min vs. (130 ± 3) beats / min], respiratory rate [(21.3 ± 2.7) breaths / min vs. (26.1 ± 2.3) breaths / min], and mean arterial pressure [(99 ± 7) mmHg vs. (109 ± 8) mmHg] in the HFHCO group were significantly lower than those in the CPAP group (t = 5.232, 5.164, 6.424; all P < 0.001). After operation, the pH value [(7.45 ± 0.05) vs. (7.45 ± 0.07)], PaO₂ [(86.5 ± 7.3) mmHg vs. (88.3 ± 6.7) mmHg], PaCO₂ [(40.1 ± 7.5) mmHg vs. (39.4 ± 6.8) mmHg], and SpO₂ [(93.9 ± 2.4)% vs. (94.1 ± 2.0)%] of the the CPAP group and HFHCO group showed no significant difference (t = 0.222, 0.468, 0.420, 0.348; P = 0.731, 0.670, 0.684, 0.697). Compared with the same group before operation, the heart rate [(86 ± 4) beats / min vs. (130 ± 3) beats / min, (87 ± 4) beats / min vs. (121 ± 3) beats / min; t = 9.826, 9.612; both P < 0.001], respiratory rate [(17.8 ± 2.5) breaths / min vs. (26.1 ± 2.3) breaths / min, (16.7 ± 2.9) breath / min vs. (21.3 ± 2.7) breaths / min; t = 8.488, 5.837; both P < 0.001], and mean arterial pressure [(78 ± 7) mmHg vs. (109 ± 8) mmHg, (77 ± 7) mmHg vs. (99 ± 7) mmHg; t = 9.104, 8.224; both P < 0.001] during operation and PaO₂ [(67.8 ± 2.6) mmHg vs. (86.5 ± 7.3) mmHg, (68.9 ± 4.0) mmHg vs. (88.3 ± 6.7) mmHg; t = 7.126, 6.395; both P < 0.001] after operation all significantly elevated in the CPAP group and HFHCO group. No serious bleeding, malignant arrhythmia, or pneumothorax occurred during the course of fiberoptic bronchoscopy in the two groups.

Conclusions

For patients with indwelling tracheal intubation or tracheotomy cannula, CPAP or HFHCO can improve their airway ventilation and PaO₂ during bronchofibroscope procedures. However, patients with HFHCO are more comfortable and HFHCO can avoid significant fluctuations in their respiratory and hemodynamic signs.

Key words: Continuous positive airway pressure, High-flow humidification cannula oxygen therapy, Fiberoptic bronchoscope

Zhichao Yang, Zhi Song, Xianghong Peng, Deyu Ji. Clinical observation of fiberoptic bronchoscopy in patients undergoing continuous positive airway pressure and high-flow humidification cannula oxygen therapy[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(03): 195-199.

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Figures/Tables 3

References 21

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组别	例次	年龄（岁）	性别比（例，男/女）	慢性阻塞性肺疾病[例（%）]	高血压[例（%）]	糖尿病[例（%）]	高脂血症[例（%）]
CPAP组	32	62 ± 3	18 / 14	8（25.0）	22（68.8）	6（18.8）	13（40.6）
HFHCO组	32	60 ± 4	17 / 15	9（28.1）	18（56.2）	8（25.0）	15（46.9）
t / χ²值	?	0.106	0.063	0.058	0.324	0.122	0.198
P值	?	0.847	0.912	0.903	0.698	0.816	0.728
组别	例次	吸烟史[例（%）]	体质量指数（kg / m²）	降钙素原（μg / L）	C反应蛋白质（mg / L）	白细胞计数（× 10⁹ / L）
CPAP组	32	17（53.1）	21 ± 3	17 ± 7	101 ± 34	14.6 ± 3.3
HFHCO组	32	19（59.4）	20 ± 4	17 ± 8	102 ± 36	15.2 ± 2.7
t / χ²值	?	0.101	0.982	0.063	0.123	0.117
P值	?	0.867	0.850	0.912	0.815	0.822

组别	例次	年龄（岁）	性别比（例，男/女）	慢性阻塞性肺疾病[例（%）]	高血压[例（%）]	糖尿病[例（%）]	高脂血症[例（%）]
CPAP组	32	62 ± 3	18 / 14	8（25.0）	22（68.8）	6（18.8）	13（40.6）
HFHCO组	32	60 ± 4	17 / 15	9（28.1）	18（56.2）	8（25.0）	15（46.9）
t / χ²值	?	0.106	0.063	0.058	0.324	0.122	0.198
P值	?	0.847	0.912	0.903	0.698	0.816	0.728
组别	例次	吸烟史[例（%）]	体质量指数（kg / m²）	降钙素原（μg / L）	C反应蛋白质（mg / L）	白细胞计数（× 10⁹ / L）
CPAP组	32	17（53.1）	21 ± 3	17 ± 7	101 ± 34	14.6 ± 3.3
HFHCO组	32	19（59.4）	20 ± 4	17 ± 8	102 ± 36	15.2 ± 2.7
t / χ²值	?	0.101	0.982	0.063	0.123	0.117
P值	?	0.867	0.850	0.912	0.815	0.822

组别	例次	心率（次/ min）		呼吸频率（次/ min）		平均动脉压（mmHg）		SaO₂（%）
组别	例次	操作前	操作中	操作前	操作中	操作前	操作中	操作前	操作中
CPAP组	32	86 ± 4	130 ± 3^a	17.8 ± 2.5	26.1 ± 2.3^a	78 ± 7	109 ± 8^a	96.1 ± 2.6	94.3 ± 2.3
HFHCO组	32	87 ± 4	121 ± 3^a	16.7 ± 2.9	21.3 ± 2.7^a	77 ± 7	99 ± 7^a	96.3 ± 2.5	94.8 ± 2.5
t值	?	0.126	5.232	0.196	5.164	0.318	6.424	0.519	0.483
P值	?	0.826	< 0.001	0.792	< 0.001	0.702	< 0.001	0.606	0.667

组别	例次	心率（次/ min）		呼吸频率（次/ min）		平均动脉压（mmHg）		SaO₂（%）
组别	例次	操作前	操作中	操作前	操作中	操作前	操作中	操作前	操作中
CPAP组	32	86 ± 4	130 ± 3^a	17.8 ± 2.5	26.1 ± 2.3^a	78 ± 7	109 ± 8^a	96.1 ± 2.6	94.3 ± 2.3
HFHCO组	32	87 ± 4	121 ± 3^a	16.7 ± 2.9	21.3 ± 2.7^a	77 ± 7	99 ± 7^a	96.3 ± 2.5	94.8 ± 2.5
t值	?	0.126	5.232	0.196	5.164	0.318	6.424	0.519	0.483
P值	?	0.826	< 0.001	0.792	< 0.001	0.702	< 0.001	0.606	0.667

组别	例次	pH值		PaO₂（mmHg）		PaCO₂（mmHg）		SpO₂（%）
组别	例次	操作前	操作后	操作前	操作后	操作前	操作后	操作前	操作后
CPAP组	32	7.43 ± 0.04	7.45 ± 0.05	67.8 ± 2.6	86.5 ± 7.3^a	42 ± 7	40 ± 8	92.2 ± 2.6	93.9 ± 2.4
HFHCO组	32	7.46 ± 0.03	7.45 ± 0.07	68.9 ± 4.0	88.3 ± 6.7^a	40 ± 7	39 ± 7	92.3 ± 2.5	94.1 ± 2.0
t值	?	0.166	0.222	0.293	0.468	0.338	0.420	0.207	0.348
P值	?	0.746	0.731	0.709	0.670	0.698	0.684	0.744	0.697

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