High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy--a prospective randomised trial

Marcel Simon, Stephan Braune, Daniel Frings, Ann-Kathrin Wiontzek, Hans Klose, Stefan Kluge, Marcel Simon, Stephan Braune, Daniel Frings, Ann-Kathrin Wiontzek, Hans Klose, Stefan Kluge

Abstract

Introduction: Critically ill patients with respiratory failure undergoing bronchoscopy have an increased risk of hypoxaemia-related complications. Previous studies have shown that in awake, hypoxaemic patients non-invasive ventilation (NIV) is helpful in preventing gas exchange deterioration during bronchoscopy. An alternative and increasingly used means of oxygen delivery is its application via high-flow nasal cannula (HFNC). This study was conducted to compare HFNC with NIV in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy.

Methods: Prospective randomised trial randomising 40 critically ill patients with hypoxaemic respiratory failure to receive either NIV or HFNC during bronchoscopy in the intensive care unit.

Results: After the initiation of NIV and HFNC, oxygen levels were significantly higher in the NIV group compared to the HFNC group. Two patients were unable to proceed to bronchoscopy after the institution of HFNC due to progressive hypoxaemia. During bronchoscopy, one patient on HFNC deteriorated due to intravenous sedation requiring non-invasive ventilatory support. Bronchoscopy was well tolerated in all other patients. There were no significant differences between the two groups regarding heart rate, mean arterial pressure and respiratory rate. Three patients in the NIV group and one patient in the HFNC group were intubated within 24 hours after the end of bronchoscopy (P = 0.29).

Conclusions: The application of NIV was superior to HFNC with regard to oxygenation before, during and after bronchoscopy in patients with moderate to severe hypoxaemia. In patients with stable oxygenation under HFNC, subsequent bronchoscopy was well tolerated.

Trial registration: ClinicalTrials.gov NCT01870765. Registered 30 May 2013.

Figures

Figure 1
Figure 1
Study workflow. Abbreviations: ABG, arterial blood gas analysis; FiO2, fraction of inspired oxygen; HFNC, high-flow nasal cannula; NIV, non-invasive ventilation.
Figure 2
Figure 2
Illustration of bronchoscopy using HFNC (A) or NIV (B). HFNC, high-flow nasal cannula; NIV, non-invasive ventilation.
Figure 3
Figure 3
SpO2at baseline, pre and post bronchoscopy. Changes in SpO2. Values are given as mean and standard deviation. HFNC, high-flow nasal cannula; NIV, non-invasive ventilation; SpO2, oxygen saturation recorded by pulse oximetry.
Figure 4
Figure 4
PaO2/FiO2and PaCO2at baseline, pre and post bronchoscopy. Changes in PaO2/FiO2(A) and PaCO2(B). Values are given as mean and standard deviation. *P <0.05; n.s. not significant. FiO2, fraction of inspired oxygen; HFNC, high-flow nasal cannula; NIV, non-invasive ventilation; PaCO2, partial pressure of carbon dioxide in arterial blood; PaO2, partial pressure of oxygen in arterial blood.

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