High-flow nasal oxygen for bronchoalveolar lavage in acute respiratory failure patients

Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) holds significant risks of oxygenation deterioration [1]. Among various means to improve oxygenation during BAL, noninvasive positive pressure ventilation (NPPV) has received the greatest attention [2, 3]. However, NPPV is a time-consuming and very demanding technique. High-flow nasal cannula oxygen therapy (HFNC) has emerged as a technique for noninvasive respiratory management of hypoxaemic patients [4]. In patients with acute respiratory failure (ARF), its beneficial effects have been shown in various populations [5], and its effectiveness and superiority over NPPV and conventional oxygenation recently demonstrated [6]. Its use has also been described during bronchoscopy in non-hypoxaemic [7] and in hypoxaemic patients in comparison with NPPV [8]. However, bronchoscopy was performed with an open mouth in both studies, which considerably reduces HFNC efficacy [9]. Thus, we aimed to determine HFNC's effectiveness during nasal bronchoscopy with BAL in patients with ARF along with BAL's feasibility and yield. HFNC is an effective and safe method of oxygenation during nasal bronchoscopy with BAL in hypoxaemic ARF patients Jonathan Messika, Muriel Fartoukh and Jean-Damien Ricard are members of the GREPI (French Group for Research and Education in Respiratory Infectious Diseases).