This prospective randomized controlled study investigated whether nasal probe tests could improve the flexible bronchoscopy procedure with respect to shortening the operation time and reducing postoperative complications. The results showed that probing the nasal cavity before flexible bronchoscopy significantly reduced the time to reach the glottis and improved the first-pass intubation success rate. Moreover, probing with cotton buds soaked in a mixture of 1‱ adrenaline and 2% lidocaine reduced nasal bleeding after flexible bronchoscopy.
Regarding the efficiency of this novel method, the results showed that flexible bronchoscopy with probing support reduced the manipulation time compared with the conventional approach. Probing with cotton buds allowed initial definition of the nasal cavity anatomy. Moreover, moist cotton buds could lubricate the nasal mucous membranes, which allows easier passage of the work channel through the nasal passages. Compared with the conventional approach, nasal detection resulted in time-saving for flexible bronchoscopy, which indicates that prior detection, rather than the bronchoscope itself, is more important for reducing time during the process. Moreover, the number of intubation attempts in the experimental group was lower than that in the control group, which confirmed the practical value of the time-consuming flexible bronchoscopy.
Regarding the safety of this novel method, the results showed that it had fewer additional complications than the conventional approach. Bleeding is among the most concerning complications of bronchoscopy and endotracheal intubation.9.10 Apart from biopsy-related bleeding, bleeding caused by mechanical friction could cause anxiety and affect the quality of life of patients. We found that prior probing was associated with less nasal bleeding and that adrenaline, which reduced the insertion attempts, protected the nasal mucosa, shrunk the capillaries, and reduced bleeding.
Since the introduction of the bronchoscope in 1966, it has become an increasingly important tool in the diagnosis and treatment of pulmonary diseases.11 Moreover, bronchoscopy has emerged as a tool for improving the management of complex lung diseases.12 Therefore, there is a need to maximize the utility of flexible bronchoscopy, simplify its operating process, and reduce postoperative complications. There have been several studies on bronchoscopy,13–16 however, there have been few studies on the examination of the nasal passages before bronchoscopy. To our knowledge, there has been no study on the influence of nasal cavity probing. Therefore, the current study shows that the use of nasal probe tests can reduce the postoperative complications which have clinical importance given the previously described side effects associated with flexible bronchoscopy.17 Second, nasal probe tests can decrease the procedure time and the number of operations performed before successful flexible bronchoscopy. They could enhance hospital single-day testing capabilities and reduce the incidence of bacteremia and post-bronchoscopy fever.18 Geertje et al described 66 flexible bronchoscopies in non-sedated adults.16 They found that the median time to reaching the glottis with nasal and oral insertion was 52.33 s and 24.43 s, respectively, which was consistent with our findings. This shows that the time to pass the glottis could be reduced by smooth probing or bypassing the nasal cavity. Furthermore, the nasal probes are easy to perform, low cost, and easy to spread. Moreover, they can be applied in other medical procedures, including transnasal gastroscopy and nasotracheal intubation.
Regarding this study’s strengths, this is the first prospective randomized controlled trial to assess the efficiency of probing the nasal cavity. The study sought to contribute to optimizing the nasal passage method during flexible bronchoscopy. This study has several limitations. First, nasal insertion was the first choice for the patients who underwent bronchoscopy; however, we used a 6.0-mm bronchoscope. Using a bronchoscope with a greater diameter could affect the time to pass the glottis and increase discomfort. There is a need for future studies using a 5.0-mm bronchoscope. Second, regarding bronchoscopy, the learning curve should be considered. Third, these findings have limited generalizability since this was a single-center study. Multicenter studies should confirm the reliability of these findings.