NIRS Clinical Trial
Official title:
The Systemic and Brain Oxygen Stauration Change During Bronchoscopy
Bronchofiberoscopy is a widespread invasive intervention in clinical practice with a number
of diagnostic and therapeutic indications. The Clinic of Pulmonary Medicine in Debrecen
carries out nearly 2000 examinations a year. The intervention is guided by the recommendation
of the Vocational College for Pulmonary Medicine in 2005, but it does not contain a clear
recommendation on the oxygen therapy used during the intervention. The Hungarian
recommendation states that pulsoximetry is mandatory in bronchoscopy, but it does not contain
information on the indications and the implementation of oxygen suplementation. The British
Thoracic Society Guideline 2013 deals with the issue and makes the following statements:
- patients should be monitored for oxygen saturation under bronchofiberoscopy
- oxygen supplementation during the test is recommended if the patient's desaturation is
significant (greater than 4% or less than 90%) and is over 1 minute
- during the bronchoscopy, the occurrence of oxygen saturation decreases depending on the
level of initial oxygen saturation, respiratory function, co-morbidity, sedation and the
course of intervention.
The aim of our study is to investigate the frequency with which systemic hypoxia occurs
during bronchoscopy, what factors may contribute to its development and how the level of
cerebral oxygen saturation changes with systemic desaturation (in the case of NIRS, a 20%
reduction from baseline is considered significant).
: Consecutive patients admitted to Bronchology Laboratory of Department of Pulmonology,
University of Debrecen for flexible bronchoscopy were asked to participate in the study.
After explaining the procedure in detail, all patients gave written informed consent.
The indication of flexible bronchoscopy was based in all cases on the results of medical
history, physical examination, chest X-ray and/or chest CT scan, lung function tests and
laboratory parameters including hemoglobin concentration, hemostasis variables as well as
blood gas analysis when necessary.
Bronchoscopy (PENTAX EB-1975K) was performed after an at least 4-hour fasting period. The
procedure was performed either in sitting or supine position after a topical administration
of lidocaine 2% solution. Routine monitoring consisted of ECG, non-invasive blood pressure
measurement, pulse oxymetry (finger probe). As an additional monitoring tool, near infrared
monitoring sensor was placed to the forhead of the dominant hemisphere of patients for
monitoring cerebral oxygen saturation. INVOS 5100 C cerebral oximeter (Covidien llc, 15
Hampshire Street, Mansfield, MA 02048 USA) was used for cerebral near infrared spectroscopy
measurements.
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