Evidence for most guideline recommendations on bronchoscopy related to sedation, monitoring, and recovery was determined to be low to moderate, and it did not adequately reflect patients with lung disease, according to the results of a recent review published in BMC Pulmonary Medicine.
This review searched MEDLINE and AWMF.org for official guidelines, recommendations, or consensus statements on bronchoscopy. Information about bronchoscopy with maintained spontaneous breathing and recommendations regarding intra- and postprocedural monitoring and sedation were of primary interest.
The strength of evidence behind the recommendations was then determined and assigned a grade.
In total, 6 guidelines on general bronchoscopy and 3 expert statements on special bronchoscopic procedures were identified from 2010 to 2020. Of these, 4 of the guidelines were considered to be evidence based.
The preferred sedation administration was a combination of midazolam and an opioid, and standard monitoring consisted of noninvasive blood pressure and pulse oximetry.
Only 2 of the guidelines discussed a 2-hour recovery time, but no recommendation was given.
The study authors wrote, “The recommendations in the reviewed guidelines resemble [each other] in content but differ in the strength of recommendations.” They added, “For most issues, the underlying evidence is low or moderate.”
The researchers believe that future guidelines should include more evidence about capnometry and recovery time and more recommendations specifically for patients with chronic lung disease.
Strohleit D, Galetin T, Kosse N, Lopez-Pastorini A, Stoelben E. Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review. BMC Pulm Med. 2021;21(1):198. doi:10.1186/s12890-021-01532-4