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




High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy - a prospective randomised trial - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 18:712

First Online: 22 December 2014Received: 22 July 2014Accepted: 08 December 2014

Abstract

IntroductionCritically 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.

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

ResultsAfter 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.

ConclusionsThe 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 registrationClinicalTrials.gov NCT01870765. Registered 30 May 2013.

AbbreviationsBALbronchoalveolar lavage

CPAPcontinuous positive airway pressure

FBflexible bronchoscopy

FiO2fraction of inspired oxygen

HFNChigh-flow nasal cannula

ICUintensive care unit

NIVnon-invasive ventilation

PaCO2partial pressure of carbon dioxide in arterial blood

PaO2partial pressure of oxygen in arterial blood

PEEPpositive end-expiratory pressure

SAPS IIsimplified acute physiology score II

SpO2oxygen saturation recorded by pulse oximetry

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0712-9 contains supplementary material, which is available to authorized users.

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

Source: https://link.springer.com/







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