Comparison of oxygenation among different supplemental oxygen methods during flexible bronchoscopy in infants

Background: Supplemental oxygen (O-2) is mandatory during flexible bronchoscopy (FB) in infants, but there are limited studies that deal with the efficacy of different O-2 delivery methods. This study aims to compare the oxyhemoglobin saturation in infants during FB among three different O-2 delivery methods, as measured by pulse oximeter (SpO(2)). Methods: A prospective study enrolled infants with two criteria: (1) less than 2 years old; and (2) needing FB examination. All infants received intravenous sedation and topical anesthesia. They were randomly placed into the following three groups: (1) nasal cannula (NC; 0.5 L/kg/min); (2) nasal prongs with continuous positive airway pressure (NP-CPAP; 5-10 L/min, pressure 5 cmH(2)O); and (3) nasopharyngeal catheter (NPC; 0.3-0.5 L/kg/min). SpO(2), heart rate, blood pressure and respiratory rate were measured and compared at different stages: (1) prior to the FB (baseline); the FB tip at (2) the nose tip; (3) the pharynx; (4) the carina and (5) 30 minutes after the FB. Results: A total of 75 infants, with 25 infants per group, were enrolled during a 2-year period. There were no significant differences in basic characteristics and baseline SpO(2). After the designated O-2 was delivered, SpO(2) decreased significantly (p < 0.05) when the FB tip was advanced from the nostril to the pharynx, and further decreased (p < 0.01) when at the carina in all groups, especially in the NC group. After FB, SpO(2) returned to baseline levels in all three groups. The NC group had the lowest SpO(2) at the pharynx (p < 0.01) and carina (p < 0.01). The NP-CPAP and NPC groups had better SpO(2). Conclusion: Supplemental O-2 via NPC is a simple and cost-effective method to maintain good SpO(2) during FB examination of infants. Copyright (C) 2011 Elsevier Taiwan LLC and the Chinese Medical Association. All rights reserved.