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; I2 = 62%) and procedure interruptions (OR 0.18, 95% CI 0.09-0.34; P < 0.00001; I2 = 21%). HFNC also increased the lowest SpO2 (MD = 5.89%, 95% CI 3.19-8.58; P < 0.0001; I2 = 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.
Occupational respiratory diseases pose a considerable health challenge in various industries, especially within the global seafood processing sector. The intricate interactions between lifestyle, pre-existing medical disorders and occupational exposures pose a serious threat to respiratory health. This cross-sectional study explores the respiratory health crisis among mussel workers in Kozhikode District, Southern India. The study aimed to quantify lung function morbidity and the prevalence of respiratory illnesses in this population. Pulmonary function test revealed key finding, including a concerning prevalence of respiratory impairment among mussel workers (21.5 %). Cough with phlegm (14 %), sinusitis (11.8 %), wheezing (4.3 %), shortness of breath (4.3 %), epistaxis (6.5 %), and most significantly, hemoptysis (3 %), other symptoms vertigo (7.53 %) and ophthalmic complaints (4.3 %) were observed. Significant correlations between lung health and variables such as alcohol consumption, history of tuberculosis, smoking, adherence to personal protective equipment (PPE) were determined. The occupational practice of marine mussel harvesting through breath-hold free-diving imposes significant pulmonary risk. Our findings demonstrate that mussel pickers develop a mixed obstructive and restrictive pulmonary impairment. This pathology may be driven by the synergistic effects of repetitive mechanical lung injury.

