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DOI: https://doi.org/10.4046/trd.2020.0002    [Accepted]
Published online July 9, 2020.
Risk factors for predicting hypoxia in adult patients undergoing bronchoscopy under sedation
Ji Soo Choi, 1, Eun Hye Lee, 1, Sang Hoon Lee, 2, Ah Young Leem, 2, Kyung Soo Chung, 2, Song Yee Kim, 2, Ji Ye Jung, 2, Young Ae Kang, 2, Moo Suk Park, 2, Joon Chang, 2, Young Sam Kim, M.D., Ph.D.2
1Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
2Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Correspondence:  Young Sam Kim, Tel: 82-10-7175-6067, Fax: 82-2-393-6884, 
Email: ysamkim@yuhs.ac
Received: 17 January 2020   • Revised: 26 June 2020   • Accepted: 9 July 2020
Abstract
Background
Flexible bronchoscopy is one of the most essential procedures for diagnosis and treatment of pulmonary disease. This study aimed to identify the risk factors associated with the occurrence of hypoxia in adults undergoing flexible bronchoscopy under sedation.
Methods
We retrospectively analyzed 2,520 patients who underwent flexible bronchoscopy under sedation at our tertiary care university hospital in South Korea between January 1, 2013 and December 31, 2014. Hypoxia was defined as more than 5%-point reduction in the baseline percutaneous oxygen saturation (SpO2) or SpO2 < 90% for >1 min during the procedure.
Results
The mean age was 64.7 ± 13.5 years, and 565 patients developed hypoxia during the procedure. The mean sedation time and midazolam dose for sedation were 31.1 minutes and 3.9 mg respectively. Bivariate analysis showed that older age, a low forced expiratory volume in 1 second (FEV1), use of endobronchial ultrasound, the duration of sedation, and the midazolam dose were associated with the occurrence of hypoxia during the procedure, while multivariate analysis found that age > 60 years (odds ratio [OR] 1.32), a low FEV1 (OR 0.99), and a longer duration of sedation (>40 min; OR 1.33) were significant risk factors.
Conclusions
The present findings suggest that patients older than 60 years and those with a low FEV1 tend to develop hypoxia during bronchoscopy under sedation. Moreover, longer duration of sedation (>40 min) was a significant risk factor for hypoxia.
Key Words: Bronchoscopy, Hypoxia, Risk factors
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