Tuberc Respir Dis.  2019 Jan;82(1):81-85. 10.4046/trd.2017.0104.

Clinical Effectiveness of High-Flow Nasal Cannula in Hypoxaemic Patients during Bronchoscopic Procedures

• Chung SM
• Choi JW
• Lee YS
• Choi JH
• Oh JY
• Min KH
• Hur GY
• Lee SY
• Shim JJ
• Kang KH

• KMID: 2441733
• DOI: http://doi.org/10.4046/trd.2017.0104

Abstract

BACKGROUND
Bronchoscopy is a useful diagnostic and therapeutic tool. However, the clinical use of high-flow nasal cannula (HFNC) in adults with acute respiratory failure for diagnostic and invasive procedures has not been well evaluated. We present our experiences of well-tolerated diagnostic bronchoscopy as well as cases of improved saturation in hypoxaemic patients after a therapeutic bronchoscopic procedure.
METHODS
We retrospectively reviewed data of hypoxaemic patients who had undergone bronchoscopy for diagnostic or therapeutic purposes from October 2015 to February 2017.
RESULTS
Ten patients (44-75 years of age) were enrolled. The clinical purposes of bronchoscopy were for diagnosis in seven patients and for intervention in three patients. For the diagnoses, we performed bronchoalveolar lavage in six patients. One patient underwent endobronchial ultrasonography with transbronchial needle aspiration of a lymph node to investigate tumour involvement. Patients who underwent bronchoscopy for therapeutic interventions had endobronchial mass or blood clot removal with cryotherapy for bleeding control. The mean saturation (SpO2) of pre-bronchoscopy in room air was 84.1%. The lowest and highest mean saturation with HFNC during the procedure was 95% and 99.4, respectively. The mean saturation in room air post-bronchoscopy was 87.4%, which was 3.3% higher than the mean room air SpO2 pre-bronchoscopy. Seven patients with diagnostic bronchoscopy had no hypoxic event. Three patients with interventional bronchoscopy showed improvement in saturation after the procedure. Bronchoscopy was well tolerated in all 10 cases.
CONCLUSION
This study suggests that the use of HFNC in hypoxaemic patients during diagnostic and therapeutic bronchoscopy procedures has clinical effectiveness.

Keyword

Bronchoscopy; Cannula; Hypoxia; Oxygen; Hypoxemia

MeSH Terms

Adult
Anoxia
Bronchoalveolar Lavage
Bronchoscopy
Catheters*
Cryotherapy
Diagnosis
Hemorrhage
Humans
Lymph Nodes
Needles
Oxygen
Respiratory Insufficiency
Retrospective Studies
Treatment Outcome*
Ultrasonography
Oxygen

Figure

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  Figure 1 (A) Prebronchoscopy and postbronchoscopy saturation and SpO2/FiO2 ratio in diagnostic bronchoscopy. (B) Prebronchoscopy and postbronchoscopy saturation and SpO2/FiO2 ratio in therapeutic intervention. SpO2: peripheral arterial pulse oximetry; FiO2: fraction of inspired oxygen.

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