Pulmonary Procedures |

High-Flow Nasal Cannula Oxygen Delivery During Bronchoscopy With Bronchoalveolar Lavage in Hypoxemic Patients: Analysis of 16 Cases FREE TO VIEW

Kyungchan Kim, MD; Daesung Hyun; Sangwoo Shim
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Catholic University of Daegu Hospital, Daegu City, Korea (the Republic of)

Chest. 2015;148(4_MeetingAbstracts):824A. doi:10.1378/chest.2270449
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SESSION TITLE: Interventional Pulmonology Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: While the diagnostic bronchoscopy is a safe procedure, bronchoalveolar lavage (BAL) may cause serious hypoxemia to be followed by the endotracheal intubation. To prevent hypoxemia during BAL, non-invasive ventilation (NIV) can be used, which should be performed by experienced clinician because of its technical difficulties. Recently, high-flow nasal cannula (HFNC) oxygen delivery was introduced to various situations of hypoxemia. We evaluated effectiveness and safety of HFNC oxygen delivery during BAL in hypoxemic patients.

METHODS: We retrospectively investigated cases undergoing bronchoscopy with BAL who visited in Catholic University of Daegu Hospital, between March, 2013 and February, 2015. We analyzed 16 cases of BAL of 15 patients (8 men, 7 women, age 23-80 years). During bronchoscopy with BAL in spontaneous breathing hypoxemic patients, Optiflow (Fisher&Paykel, New Zealand) was applied as a HFNC oxygen delivery system. Oxygen saturation was measured by pulse oximeter (SpO2) and less than 90% of SpO2 was defined to hypoxemia. Both fraction of inspired oxygen (FiO2) and SpO2 was measured before/during/after BAL and complications also examined within 24 hours after BAL.

RESULTS: Baseline FiO2/PaO2 was 168.4(±44.1). All oxygen devices were replaced by Optiflow, just before bronchoscopy. Before Bronchoscopy with BAL, FiO2 was 0.52(±0.1) and then SpO2 was 95.3(±3.1)%. During BAL, Optiflow was used for 48.9(±4.2) L/min of flow and FiO2 was increased to 0.76(±0.2) and then SpO2 was 93.8(±3.9)%. After BAL, FiO2 was 0.56(±0.1) and then SpO2 was 95.9(±2.8)%. BAL was successfully performed in all patients and some of complications were found; one hypotension and three transient hypoxemia. This hypoxemia did not caused endotracheal intubation.

CONCLUSIONS: In spontaneous breathing hypoxemic patients, HFNC oxygen delivery can be applied for bronchoscopy with BAL without subsequent endotracheal intubation.

CLINICAL IMPLICATIONS: HFNC oxygen delivery may be an optional tool for bronchoscopy with BAL in hypoxemic patients.

DISCLOSURE: The following authors have nothing to disclose: Kyungchan Kim, Daesung Hyun, Sangwoo Shim

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