DOI: 10.1097/lbr.0000000000001084 ISSN: 1948-8270

Hemodynamic Effects of Topical Oxymetazoline During Pediatric Flexible Bronchoscopy

Alex J. Katz, Haley Haskett, Lauren M.C. Grant, Aoife Corcoran, Antoinette W. Daou, Pelton Phinizy, Benjamin B. Bruins, Vanessa M. Mazandi, Kumaran Senthil, Joseph Piccione, Jelte Kelchtermans
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Background:

Bleeding is a well-recognized complication in flexible bronchoscopy, especially with advanced procedures. Oxymetazoline is a topical vasoconstrictor often used to reduce or treat bleeding in the nares and airways.

Methods:

A retrospective cohort study was conducted on pediatric patients undergoing flexible bronchoscopy from 2015 to 2025. Language processing was used to analyze bronchoscopy-related procedures, and mixed-effects logistic regression models were used to compare blood pressure, heart rate, and rescue medication use in cohorts that were exposed to nasal, endobronchial, and no oxymetazoline.

Results:

A total of 2874 patients (41% female, mean age: 5.8 y) underwent 3978 bronchoscopies, 66 (2%) of which were exposed to endobronchial oxymetazoline and 1039 (26%) to nasal oxymetazoline. Endobronchial oxymetazoline was associated with higher systolic blood pressure ( β =5.73; 95% CI: 2.48-8.98; P =0.00067), diastolic blood pressure ( β =3.68; 95% CI: 1.41-5.96; P =0.0016), and lower heart rate ( β =−6.91; 95% CI: −10.84 to –3.00; P =0.00054). These effects were more pronounced when bleeding was reported. Endobronchial oxymetazoline was associated with increased bradycardia (OR: 1.92; 95% CI: 1.09-3.40; P =0.024), but not with increased rescue medication use (OR: 0.69; 95% CI: 0.38-1.24; P =0.21).

Conclusion:

Endobronchial and nasal oxymetazoline use during pediatric flexible bronchoscopy is associated with a mild increase in blood pressure and a decrease in heart rate, although it is well-tolerated and appears to be safe without an increased need for clinical intervention.

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