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Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review
BACKGROUND: Patients undergoing bronchoscopy in spontaneous breathing are prone to hypoxaemia and hypercapnia. Sedation, airway obstruction, and lung diseases impair respiration and gas exchange. The restitution of normal respiration takes place in the recovery room. Nonetheless, there is no evidenc...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193886/ https://www.ncbi.nlm.nih.gov/pubmed/34112130 http://dx.doi.org/10.1186/s12890-021-01532-4 |
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author | Strohleit, Daniel Galetin, Thomas Kosse, Nils Lopez-Pastorini, Alberto Stoelben, Erich |
author_facet | Strohleit, Daniel Galetin, Thomas Kosse, Nils Lopez-Pastorini, Alberto Stoelben, Erich |
author_sort | Strohleit, Daniel |
collection | PubMed |
description | BACKGROUND: Patients undergoing bronchoscopy in spontaneous breathing are prone to hypoxaemia and hypercapnia. Sedation, airway obstruction, and lung diseases impair respiration and gas exchange. The restitution of normal respiration takes place in the recovery room. Nonetheless, there is no evidence on the necessary observation time. We systematically reviewed current guidelines on bronchoscopy regarding sedation, monitoring and recovery. METHODS: This review was registered at the PROSPERO database (CRD42020197476). MEDLINE and awmf.org were double-searched for official guidelines, recommendation or consensus statements on bronchoscopy from 2010 to 2020. The PICO-process focussed on adults (Patients), bronchoscopy with maintained spontaneous breathing (Interventions), and recommendations regarding the intra- and postprocedural monitoring and sedation (O). The guideline quality was graded. A catalogue of 54 questions was answered. Strength of recommendation and evidence levels were recorded for each recommendation. RESULTS: Six guidelines on general bronchoscopy and three expert statements on special bronchoscopic procedures were identified. Four guidelines were evidence-based. Most guidelines recommend sedation to improve the patient’s tolerance. Midazolam combined with an opioid is preferred. The standard monitoring consists of non-invasive blood pressure, and pulse oximetry, furthermore electrocardiogram in cardiac patients. Only one guideline discusses hypercapnia and capnometry, but without consensus. Two guidelines discuss a recovery time of two hours, but a recommendation was not given because of lack of evidence. CONCLUSION: Evidence for most issues is low to moderate. Lung-diseased patients are not represented by current guidelines. Capnometry and recovery time lack evidence. More primary research in these fields is needed so that future guidelines may address these issues, too. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-021-01532-4. |
format | Online Article Text |
id | pubmed-8193886 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-81938862021-06-15 Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review Strohleit, Daniel Galetin, Thomas Kosse, Nils Lopez-Pastorini, Alberto Stoelben, Erich BMC Pulm Med Research Article BACKGROUND: Patients undergoing bronchoscopy in spontaneous breathing are prone to hypoxaemia and hypercapnia. Sedation, airway obstruction, and lung diseases impair respiration and gas exchange. The restitution of normal respiration takes place in the recovery room. Nonetheless, there is no evidence on the necessary observation time. We systematically reviewed current guidelines on bronchoscopy regarding sedation, monitoring and recovery. METHODS: This review was registered at the PROSPERO database (CRD42020197476). MEDLINE and awmf.org were double-searched for official guidelines, recommendation or consensus statements on bronchoscopy from 2010 to 2020. The PICO-process focussed on adults (Patients), bronchoscopy with maintained spontaneous breathing (Interventions), and recommendations regarding the intra- and postprocedural monitoring and sedation (O). The guideline quality was graded. A catalogue of 54 questions was answered. Strength of recommendation and evidence levels were recorded for each recommendation. RESULTS: Six guidelines on general bronchoscopy and three expert statements on special bronchoscopic procedures were identified. Four guidelines were evidence-based. Most guidelines recommend sedation to improve the patient’s tolerance. Midazolam combined with an opioid is preferred. The standard monitoring consists of non-invasive blood pressure, and pulse oximetry, furthermore electrocardiogram in cardiac patients. Only one guideline discusses hypercapnia and capnometry, but without consensus. Two guidelines discuss a recovery time of two hours, but a recommendation was not given because of lack of evidence. CONCLUSION: Evidence for most issues is low to moderate. Lung-diseased patients are not represented by current guidelines. Capnometry and recovery time lack evidence. More primary research in these fields is needed so that future guidelines may address these issues, too. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-021-01532-4. BioMed Central 2021-06-10 /pmc/articles/PMC8193886/ /pubmed/34112130 http://dx.doi.org/10.1186/s12890-021-01532-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Strohleit, Daniel Galetin, Thomas Kosse, Nils Lopez-Pastorini, Alberto Stoelben, Erich Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review |
title | Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review |
title_full | Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review |
title_fullStr | Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review |
title_full_unstemmed | Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review |
title_short | Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review |
title_sort | guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193886/ https://www.ncbi.nlm.nih.gov/pubmed/34112130 http://dx.doi.org/10.1186/s12890-021-01532-4 |
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