Search for a command to run...
Introduction: Hypoxemia is a frequent complication during bronchoscopy, and optimal oxygenation strategies remain clinically important. Previous evidence suggests that high-flow nasal cannula (HFNC) may outperform conventional oxygen therapy (COT). We conducted an updated systematic review and meta-analysis to incorporate recent trials and provide a comprehensive assessment of HFNC’s efficacy. Methods: PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing HFNC with COT in adult patients undergoing bronchoscopy. Outcomes included the incidence of hypoxemia, the lowest SpO2, procedure duration, patient comfort, and sedation dose. Pooled data were analyzed using a random-effects model, with results reported as risk ratios (RR), mean differences (MD), or standardized mean differences (SMD), as appropriate. Heterogeneity was assessed using the Cochran Q test and I2 statistic. Results: Seventeen RCTs (n=2,727) were included; 1,344 patients (49.2%) received HFNC. HFNC significantly reduced the risk of hypoxemia (RR 0.40; 95% CI 0.28–0.57; p< 0.0001), increased minimum SpO2 (MD +4.78 percentage points; 95% CI 3.21–6.35; p< 0.0001), and shortened procedure time (MD –0.90 minutes; 95% CI –1.68 to –0.11; p=0.026). There was no significant difference in patient comfort (SMD –0.07; 95% CI –0.25 to 0.11; p=0.46). Sedation requirements were slightly higher in the HFNC group (SMD 0.17; 95% CI 0.04–0.29; p=0.008). Conclusions: HFNC significantly reduces hypoxemic events, improves oxygenation, and shortens procedure time compared to COT during bronchoscopy. Despite a small increase in anesthetic use, patient comfort was unaffected. These findings support the preferential use of HFNC during bronchoscopy, particularly when minimizing desaturation is a priority.