Evaluation of hypercapnia during and after flexible bronchoscopy with endobronchial ultrasound in patients with and without COPD

• Conditions: J44; D38.3; Other chronic obstructive pulmonary disease; Mediastinum

• Registration Number: DRKS00015748
• Lead Sponsor: ungenklinikKliniken der Stadt Köln gGmbH, Standort Merheim

Brief Summary

Background: Flexible bronchoscopy (FB) in analgosedation causes alveolar hypoventilation and hypercapnia, the more so if patients suffer from COPD. Nonetheless, neither is capnometry part of standard monitoring nor is there evidence on how long patients should be monitored after sedation. Objectives: We investigated the impact of COPD on hypercapnia during FB with endobronchial ultrasound (EBUS) in sedation and how the periprocedural monitoring should be adapted. Methods: Two cohorts of consecutive patients – with advanced and without COPD – with the indication for FB with EBUS-guided transbronchial needle aspiration in analgosedation received continuous transcutaneous capnometry (ptcCO2) before, during, and for 60 min after the sedation with midazolam and alfentanil. Main Results: Forty-six patients with advanced COPD and 44 without COPD were included. The mean examination time was 26 ± 9 min. Patients with advanced COPD had a higher peak ptcCO2 (53.7 ± 7.1 vs. 46.8 ± 4.8 mm Hg, p < 0.001) and mean ptcCO2 (49.5 ± 6.8 vs. 44.0 ± 4.4 mm Hg, p < 0.001). Thirty-six percent of all patients reached the maximum hypercapnia after FB in the recovery room (8 ± 11 min). Patients with COPD needed more time to recover to normocapnia (22 ± 24 vs. 7 ± 11 min, p < 0.001). They needed a nasopharyngeal tube more often (28 vs. 11%, p < 0.001). All patients recovered from hypercapnia within 60 min after FB. No intermittent ventilation manoeuvres were needed. Conclusion: A relevant proportion of patients reached their peak-pCO2 after the end of intervention. We recommend using capnometry at least for patients with known COPD. Flexible EBUS in analgosedation can be safely performed in patients with advanced COPD. For patients with advanced COPD, a postprocedural observation time of 60 min was sufficient.

Detailed Description

Not available

Study Timeline

• Study Start: 2018-10-17
• Study Completion: 2019-12-02
• Results First Posted: 2021-04-13
• Last Update Posted: 19 August 2024

Recruitment & Eligibility

• Status: Complete
• Sex: All
• Target Recruitment: 106

Inclusion Criteria

COPD group: COPD with FEV1 (Forced Expiratory Pressure in 1 Second) <60% or emphysema with DLCO/AV (Diffusing capacity for carbon monoxide) <60%
control group: no COPD
elective indication for flexible bronchoscopy with EBUS
written consent

Exclusion Criteria

severe bleeding disorders
Missing lung function test
pregnancy or lactation

Study & Design

• Study Type: observational
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Peak-pCO2 during EBUS (Endobronchial Ultrasound)

Secondary Outcome Measures

Name	Time	Method
time to recovery of hypercapnia<br>number and duration of apnoea