Chest
Volume 121, Issue 4, April 2002, Pages 1350-1354
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Bronchoscopy
Management of Acute Hypoxemia During Flexible Bronchoscopy With Insertion of a Nasopharyngeal Tube in Lung Transplant Recipients

https://doi.org/10.1378/chest.121.4.1350Get rights and content

Study objectives

To assess the utility of nasopharyngeal tube insertion in the management of hypoxemia during flexible bronchoscopy (FB) in lung transplant recipients, and to determine the incidence and risk factors of upper-airway obstruction (UAO) leading to significant hypoxemia during FB.

Setting

Heart-lung transplant unit of a university hospital.

Patients and methods

Ninety-six lung transplant recipients (47 men and 49 women; mean ± SD age, 41.4 ± 13.1 years) underwent 714 FB procedures from January 1997 to May 2000.

Intervention

A fall in oxygen saturation (≤ 90%) in patients receiving 6 L/min of oxygen via nasal prongs was treated with insertion of a nasopharyngeal tube, continued oxygen supplementation, and withdrawal of the bronchoscope to the trachea. If oxygen desaturation persisted at < 90% despite additional oxygen administration via a 7F catheter placed either just above the larynx or in the proximal trachea, the bronchoscope was withdrawn, reversal of sedation was administered, and bag and mask ventilation was instituted until satisfactory spontaneous ventilation was achieved.

Results

Forty-six patients (47.9%) were treated with nasopharyngeal tube insertion on 102 occasions at a mean duration of 168 ± 178 days after lung transplantation. In 90 of 102 procedures (88.2%), significant hypoxemia due to UAO was successfully treated with nasopharyngeal tube insertion. The mean oxygen saturation after nasopharyngeal tube insertion was 97 ± 3%. Male gender, increase in body mass index after lung transplantation, and presence of obstructive sleep apnea were significant factors associated with the need for nasopharyngeal tube insertion during FB in lung transplant recipients.

Conclusions

Significant oxygen desaturation during FB in lung transplant recipients is mainly due to UAO. Insertion of a nasopharyngeal tube is a novel and a highly effective approach to the management of acute hypoxemia during FB.

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.

References (19)

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