Complications during interventional rigid bronchoscopy with general anaesthesia and high-frequency jet ventilation: a 5-year retrospective pilot study

BACKGROUND High-frequency jet ventilation (HFJV) is the standard technique for rigid bronchoscopy. Few studies have comprehensively examined the complications associated with this technique. Previous evidence suggests that an ASA 4 score and basal SpO 2 less than 95% may increase the likelihood of periprocedural complications. OBJECTIVE(S) This retrospective study aimed to quantify and characterise the frequency and types of complications linked to HFJV, and to identify independent factors associated with their occurrence. DESIGN A retrospective pilot cohort study. SETTING This monocentric pilot study was conducted in a tertiary university hospital in Brussels, Belgium, between 1 January 2019, and 31 December 2023. PATIENTS A total of 1385 patients who underwent bronchoscopy under general anaesthesia were screened, of whom 833 (444 men and 389 women) met inclusion criteria and were retained for final analysis. Inclusion criteria were age at least 18 years, rigid bronchoscopy and general anaesthesia using HFJV. Exclusion criteria included endotracheal intubation, incomplete medical records or explicit refusal to allow the use of their medical records for research. MAIN OUTCOME MEASURES Complications were defined as hypoxaemia (oxygen saturation ≤ 90% for at least 1 min), hypotension (SBP < 90 mmHg), cardiac arrhythmia, laryngospasm or bronchospasm, pneumothorax or requirement for ICU admission. Univariate analyses were performed to compare groups of patients with and without complications, and variables with P less than 0.05 were entered into a backward logistic regression to identify independent predictors of complications. RESULTS Hypoxaemia and hypotension were the most frequent periprocedural events occurring in 11 and 28% of cases, respectively. Shorter stature, stent implantation and basal oxygen saturation below 96% emerged as independent predictors of incidents during HFJV for rigid bronchoscopy (logistic regression model, area under the curve 0.62 (95% CI 0.58 to 0.67). CONCLUSIONS We observed a relatively high number of minor complications associated with general anaesthesia for interventional bronchoscopy using HFJV. Shorter stature, lower basal SpO 2 and stent procedures were independent predictors of incidents; however, the model demonstrated poor predictive value and limited clinical applicability. TRIAL REGISTRATION NCT06285994.