Chest
BronchoscopyManagement of Acute Hypoxemia During Flexible Bronchoscopy With Insertion of a Nasopharyngeal Tube in Lung Transplant Recipients
Section snippets
Materials and Methods
Ninety-six lung transplant recipients (47 men and 49 women; mean ± SD age, 41.4 ± 13.1 years; range, 13.6 to 63.4 years) who underwent single or bilateral lung transplantation or heart-lung transplantation at our institution from January 1997 to May 2000 were included in the study. These patients underwent 714 bronchoscopic procedures during the study period. All patients were treated with triple-drug immunosuppression (cyclosporine, azathioprine, and prednisolone) after transplantation.
Results
Forty-six (34 men and 12 women) of the 96 patients (47.9%) included in the study were treated with insertion of nasopharyngeal tube on 102 occasions at a mean duration of 168 ± 178 days (range, 2 to 959 days) after lung transplantation. The need for nasopharyngeal tube insertion during FB was significantly higher in male patients (p < 0.05). The mean age for the patients who needed a nasopharyngeal tube was 46.3 ± 10.4 years (range, 21.2 to 63.4 years), and for those who did not need a
Discussion
Nasopharyngeal tube insertion has been described in the management of OSA.8 However, to our knowledge, its use has not been described in the management of hypoxemia during FB. Acute hypoxemia secondary to UAO despite supplemental oxygenation in patients undergoing FB under local anesthesia and sedation was successfully treated in 88.2% of procedures with insertion of a nasopharyngeal tube. The small group of patients in whom the hypoxemia did not respond to the insertion of nasopharyngeal tube
ACKNOWLEDGMENT
The authors thank Dr. David Jankelson for the sleep study results.
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2011, Journal of the Chinese Medical AssociationCitation Excerpt :Both effects may contribute to the high measured SpO2. NPC insertion for the management of upper airway obstruction during sleep has been reported in children,20,21 and in adult lung transplant patients.22 There was a study in infants that demonstrated significant increases in PEEP when receiving oxygen through an 8-F NPC.
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2011, Respiratory MedicineCitation Excerpt :With the common practice of supplemental oxygen usage to prevent hypoxemia, the measurement of carbon dioxide tension adds additional important information because hypoventilation is not reflected by pulse oximetry.5,6 TcPCO2 monitoring enabled us to identify clinically significant hypoventilation and institute appropriate therapy, including restriction of further sedation, use of reversal drugs, and/or use of upper airway support in a timely fashion.17,18 Another option would be the use of non-invasive ventilatory support by Bi-level non-invasive ventilation both during and following the procedure.