Risk Factors for Predicting Hypoxia in Adult Patients Undergoing Bronchoscopy under Sedation

High-flow nasal oxygenation versus face mask oxygenation for preoxygenation in patients undergoing double-lumen endobronchial intubation: protocol of a randomised controlled trial

INTRODUCTION

With the growing emphasis on swift recovery, minimally invasive thoracic surgery has advanced significantly. Video-assisted thoracoscopic surgery (VATS) has seen rapid development, and the double-lumen tube (DLT) remains the most dependable method for tracheal intubation in VATS. However, hypoxaemia during DLT intubation poses a threat to the perioperative safety of thoracic surgery patients. Recently, transnasal high-flow nasal oxygen (HFNO) has shown promise in anaesthesia, particularly in handling short-duration hypoxic airway emergencies. Yet, its application in the perioperative period for patients undergoing pulmonary surgery with compromised cardiopulmonary function lacks evidence, and there are limited reliable clinical data.

METHODS AND ANALYSIS

A prospective, randomised, controlled, single-blind design will be employed in this study. 112 patients aged 18-60 years undergoing elective VATS-assisted pulmonary surgery will be enrolled and randomly divided into two groups: the nasal high-flow oxygen group (H group) and the traditional mask transnasal oxygen group (M group) in a 1:1 ratio. HFNO will be used during DLT intubation for the prevention of asphyxia in group H, while conventional intubation procedures will be followed by group M. Comparison will be made between the two groups in terms of minimum oxygen saturation during intubation, hypoxaemia incidence during intubation, perioperative complications and postoperative hospital days.

ETHICS AND DISSEMINATION

Approval for this study has been granted by the local ethics committee at Shenzhen Second People's Hospital. The trial results will be disseminated through peer-reviewed journals and scientific conferences.

TRIAL REGISTRATION NUMBER

NCT05666908.

The use of non-invasive respiratory assistance to facilitate bronchofiberoscopy performance in patients with hypoxemic (type one) respiratory failure - Study protocol

PURPOSE

Bronchofiberoscopy (FOB) is a procedure routinely performed for: lung cancer, obstruction, interstitial diseases, foreign bodies' removal, airway clearance, and hemoptysis. It causes acute airway narrowing leading to respiratory and cardiovascular stress. Due to increasing number of ill patients with respiratory failure (RF), conventional oxygen therapy (COT) is frequently insufficient to assure accurate oxygenation and prevent RF in patients requiring FOB. In this clinical scenario, patients may be intubated and supported with invasive mechanical ventilation (IMV) with the specific aim of allowing a safe FOB. However, this invasive strategy is associated with an increased risk of IMV-associated complications.

MATERIALS AND METHODS

Our study is a planned prospective multicenter three-arm randomized controlled trial (RCT). The target number of 300 patients was calculated based on the intubation risk in RF patients, which is 0.2-2%. The patients will be assigned to each arm based on Horowitz index. In each arm, the patients will be randomly assigned to one out of two dedicated respiratory support methods in each group i.e. COT/high flow nasal cannula (HFNC), HFNC/non-invasive ventilation (NIV) and NIV/IMV. In the manuscript the current state of art in the area of respiratory support is discussed. We have underlined knowledge gaps in medical evidence which we are planning to reveal with our results.

RESULTS

The results of our study are clinically crucial, because they address current gaps concerning COT/HFNC/NIV/IMV.

CONCLUSION

The expected findings of this study would allow for careful selection of respiratory support method to safely perform FOB in patients with hypoxemic RF.

Biomarkers and diagnostic tools for lung cancer

Lung cancer is the leading cause of cancer-related deaths in developing to advanced countries worldwide. The incidence rate of lung cancer in Korea has been increasing steadily since 1997. Statistics show that in 2017 alone, the incidence and mortality rates for lung cancer were 52.7 and 34.8 per 100,000 people, respectively, accounting for the highest cause of cancer death in Korea. The process of accurately diagnosing lung cancer consists of several steps, starting with the discovery of pulmonary nodule(s) via a cancer screening test or various other methods followed by the collection of cells or tissues and the identification of target molecules. Thereafter, staging and the development of a therapeutic plan lead to improved clinical outcomes. After the completion of a pilot study, a nationwide lung cancer screening program was introduced in Korea; since 2019, this program has targeted population at high risk for lung cancer: men and women aged 54 to 74 years who had a smoking history of 30 pack-years or more. The frequency of detection of pulmonary nodules is increasing in proportion to the public interest in health and economic growth. In this review, we present diagnostic techniques and biomarkers that are widely used in the medical field in the hope that such information would benefit clinical practice.