Effectiveness and Safety of High-Flow Nasal Cannula Oxygen Delivery during Bronchoalveolar Lavage in Acute Respiratory Failure Patients

Eun Jin Kim, Chi Young Jung, Kyung Chan Kim, Eun Jin Kim, Chi Young Jung, Kyung Chan Kim

Abstract

Background: Bronchoalveolar lavage (BAL) is a necessary procedure for diagnosis of various lung diseases. High-flow nasal cannula (HFNC) oxygen delivery was recently introduced. This study aimed to investigate the safety and effectiveness of HFNC oxygen supply during BAL procedure in patients with acute respiratory failure (ARF).

Methods: Patients who underwent BAL while using HFNC at a partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO₂/FiO₂; PF) ratio of 300 or below among patients who had been admitted from March 2013 to May 2017 were retrospectively investigated.

Results: Thirty-three BAL procedures were confirmed. Their baseline PF ratio was 166.1±46.7. FiO₂ values before, during, and after BAL were 0.45±0.12, 0.74±0.19, and 0.57±0.14, respectively. Flow (L/min) values before, during, and after BAL were 26.5±20.3, 49.0±7.2, and 40.8±14.2, respectively. Both FiO₂ and flow during and after the procedure were significantly different from those before the procedure (both p<0.001). Oxygen saturation levels before, during, and after BAL measured by pulse oximeter were 94.8±2.9, 94.6±3.5, and 95.2±2.8%, respectively. There were no significant differences in oxygen saturation among the three groups. Complications of BAL procedure included transient hypoxemia, hypotension, and fever. However, there was no endotracheal intubation within 24 hours. Baseline PF ratio in "without HFNC" group was significantly higher than that in "with HFNC" group. There were no differences in complications between the two groups.

Conclusion: The use of HFNC during BAL procedure in ARF patients was effective and safe. However, there were no significant differences in oxygen saturation level and complications comparing "without HFNC" group in mild ARF. More studies are needed for moderate to severe ARF patients.

Keywords: Bronchoalveolar Lavage; Bronchoscopy; Nasal Cannula; Oxygen; Respiratory Failure.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Copyright©2018. The Korean Academy of Tuberculosis and Respiratory Diseases.

Figures

Figure 1. Changes in saturation measured by…
Figure 1. Changes in saturation measured by pulse oximeter (SpO2), fraction of inspired oxygen (FiO2), and gas flow rate before, during and after the bronchoalveolar lavage (BAL) using high-flow nasal cannula oxygen delivery. The FiO2 values in the table are shown as percent (%) in the graph. *p<0.001, Multiple comparison result by contrast between before BAL and during BAL, before BAL and after BAL, respectively.
Figure 2. Hemodynamic changes before, during and…
Figure 2. Hemodynamic changes before, during and after the bronchoalveolar lavage (BAL) using high-flow nasal cannula oxygen delivery. *p<0.001, †p=0.025, repeated measure one factor analysis between before BAL and during BAL, before BAL and after BAL, respectively. BP: blood pressure.

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