Rigid bronchoscopy using high-flow oxygenation and deep sedation: A feasibility, safety, and patient-reported tolerability survey

Background Rigid bronchoscopy (RB) is conventionally performed under general anesthesia with jet or mechanical ventilation in an operating room and requires anesthesiologist support. Deep sedation with high-flow oxygenation (HFO), without anesthesiologist or mechanical ventilation, has recently been used for RB at our hospital. Objectives We evaluated the feasibility, safety, and patient-reported tolerability of RB performed under deep sedation with HFO, without general anesthesia or neuromuscular blockade. Design Retrospective, single-center cohort study. Methods We reviewed our institutional registry to identify all consecutive patients who underwent therapeutic RB under deep sedation with HFO. Sedation depth was targeted to a Modified Observer’s Assessment of Alertness/Sedation score of 2 or less. Vital signs, end-tidal carbon dioxide, and oxygen saturation were continuously monitored. A patient-reported tolerability survey was administered on the procedure day and 1 week later. The primary endpoint was procedural success; secondary endpoints included intra- and post-procedural complications and patient-reported tolerability. Results Sixty-eight cases (66 patients) were analyzed between August 2023 and June 2025, including patients with ASA class III or higher (38.2%), a baseline oxygen requirement (80.9%), and urgent or emergent indications (41.2%), reflecting an unselected, all-comers cohort. Procedural success was achieved in 67 cases (98.5%), with a mean procedure time of 45.1 minutes. Complications included hypoxia (13.2%), arrhythmia (7.4%), bleeding (5.9%), and hypotension (1.5%), with no 72-hour procedure-related complications or in-hospital mortality. Sore throat and voice change occurred in 25 (36.8%) and seven (10.3%) cases, respectively, all resolving within a week. Three cases (4.4%) experienced distress during the procedure, and 94.1% were willing to undergo re-examination. Conclusions RB using HFO and deep sedation, without mechanical ventilation or anesthesiologist support, was feasible across a heterogeneous, unselected cohort, with an acceptable complication profile and favorable patient-reported tolerability. These findings support further prospective, comparative evaluation of this approach, particularly in settings with limited anesthesiology support.