HFNC reduces oxygen desaturation and procedure interruptions during bronchoscopy in high-risk patients

BACKGROUND: Patients with underlying conditions such as chronic obstructive pulmonary disease (COPD) or obesity are at high risk for hypoxemia during bronchoscopy. Whether a high-flow nasal cannula (HFNC) is superior to conventional oxygen therapy (COT) for preventing this complication is well-studied, but a focused synthesis in high-risk populations is needed. OBJECTIVES: To compare the efficacy of HFNC versus COT in preventing intraprocedural hypoxemia and other complications in high-risk patients undergoing bronchoscopy. METHODS: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for RCTs up to October 2025. Methodological quality was assessed using the Cochrane Risk of Bias tool, and data were pooled with RevMan 5.3. RESULTS: Five RCTs (1054 patients) were included. Compared to COT, HFNC significantly reduced oxygen desaturation (OR 0.14, 95 % CI 0.08-0.27; P < 0.00001; I = 62 %) and procedure interruptions (OR 0.18, 95 % CI 0.09-0.34; P < 0.00001; I = 21 %). HFNC also increased the lowest SpO (MD = 5.89 %, 95 % CI 3.19-8.58; P < 0.0001; I = 90 %). No significant difference was found in procedure duration. Sensitivity analyses confirmed the robustness of the primary findings, and the certainty of evidence was moderate for most outcomes. DISCUSSION: HFNC significantly reduces the risk of hypoxemia and procedure interruptions compared with COT in high-risk patients undergoing bronchoscopy, supporting its use to improve procedural safety in this vulnerable population. Limitations include heterogeneity partly attributable to varying hypoxemia definitions and an inability to blind personnel. REGISTRATION: PROSPERO CRD420251174924.