Preventing oxygen desaturation during bronchoscopy in COPD patients using high-flow oxygen versus standard management: the randomised controlled PROSA 2 trial.

However, COPD patients have increased periprocedural complications risk and lower oxygen saturation during bronchoscopy.

然而，慢性阻塞性肺疾病（COPD）患者在支气管镜检查过程中有增加的围手术期并发症风险，并且在检查期间氧饱和度较低。

Methods

This was an investigator-initiated, single-centre, open-label randomised controlled trialdesigned to assess the benefits of high-flow nasal oxygen compared to conventional low-flow oxygen by nasal cannula during conscious sedation for bronchoscopy in patients with COPD.

这是一项由研究者发起的单中心、开放标签的随机对照试验，旨在评估在支气管镜检查中，对于慢性阻塞性肺疾病患者在清醒镇静期间使用高流量鼻导管氧疗相较于常规低流量鼻导管氧疗的益处。

Low flow was supplied at a starting rate of 4 L·min-1 and gradually increased up to 12 L·min-1 to maintain peripheral oxygen saturation (S pO2 ) >90%.

低流量氧疗的起始速率设定为4升/分钟，并逐渐增加至12升/分钟，以维持外周血氧饱和度（SpO2）>90%。

High flow delivered starting at a rate of 60 L·min-1 and an inspiratory oxygen fraction of 0.6 was increased up to 80 L·min-1 to preserve S pO2 >90%.

从每分钟60升的流量和0.6的吸氧分数开始提供高流量氧疗，并增加至每分钟80升，以保持S pO2（血氧饱和度）>90%。

The primary end-point was cumulative hypoxaemia time.

主要终点是累积的低氧血症时间。

Results

We randomised 600 COPD cases with a median (interquartile range (IQR)) age of 69.0 (62.0-76.0) years to either high flow (n=295) or low flow (n=305).

我们随机将600例中位年龄为69.0岁（四分位数间距为62.0-76.0岁）的慢性阻塞性肺疾病（COPD）患者分为高流量组（n=295）和低流量组（n=305）。

The cumulative hypoxaemia time was 53% lower in the high-flow group (1.8% (95% CI 1.5-2.2%) versus 3.8% (95% CI 3.2-4.5%) of monitoring time; p<0.001).

高流量组的累积低氧血症时间比低流量组低53%（监测时间的1.8%（95%置信区间1.5-2.2%）对比3.8%（95%置信区间3.2-4.5%）；p<0.001）。

Additionally, the high-flow group experienced a median (IQR) of 3.0 (1.0-6.0) hypoxaemia events (S pO2 <90%) compared to 6.0 (3.0-10.0) in the low-flow group (p<0.001).

此外，高流量组的中位数（四分位数间距）为3.0（1.0-6.0）次低氧血症事件（S pO2 <90%），而低流量组为6.0（3.0-10.0）次（p<0.001）。

The low-flow group had five-fold higher odds of experiencing hypoxaemia during bronchoscopy, (OR 5.1, 95% CI 3.2-8.2; p<0.001).

低流量组在支气管镜检查期间经历低氧血症的几率是高流量组的五倍，（OR 5.1，95% CI 3.2-8.2；p<0.001）。

Conclusions

High flow is feasible, decreases cumulative hypoxaemia time and reduces hypoxaemia events during bronchoscopy in patients with COPD but does not impact patient comfort.

高流量氧疗在慢性阻塞性肺疾病（COPD）患者中是可行的，可以减少累积低氧血症时间和降低支气管镜检查期间的低氧血症事件，但对患者舒适度没有影响。