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Endobronchial spread of parenchymal metastases.

We are pleased that Drs. Golpe and Mateos found our article of interest and that they had similar findings in their smaller study. Their study confirms that transient minor desaturation is common during bronchoscopy, but we differ in our response to this finding. We are unaware of any reports of adverse consequences from transient minor desaturation of the type described in both articles. Therefore, any recommendation to administer oxygen to all patients during flexible bronchoscopy must be regarded as a non–evidence-based suggestion. Golpe and Mateos have also reported minor desaturation after the bronchoscopy procedure, and they suggest that oxygen treatment should be continued for an unspecified time after the procedure. This would increase the cost and complexity of running a bronchoscopy service (our present practice is to continue oxygen treatment after bronchoscopy only if oximetry indicates hypoxia following the procedure). The significance of transient mild desaturation (mean SD arterial oxygen saturation, 91 3%) during the recovery phase is of very uncertain significance. The patients had no instrumentation during this phase. For example, it is known that patients with moderate COPD but normal resting oxygen saturation can have significant hypoxia develop at an oxygen pressure equal to that of a commercial airliner, with a further fall to a mean saturation of 80% during mild exercise.1 These patients were all asymptomatic, and it has never been suggested that COPD patients with normal resting blood gas should be administered oxygen during flight. We are confident about the safety of our present practice of administering oxygen only to patients who have sustained hypoxia develop (or to those with high-risk features, such as angina).