title: High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy--a prospective randomised trial.
abstract: BACKGROUND
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01870765. Registered 30 May 2013.
authors.affiliation: Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. m.simon@uke.de.
authors.forename: Marcel
authors.initials: M
authors.lastname: Simon
authors.affiliation: Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. sbraune@uke.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Braune
authors.affiliation: Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. d.frings@uke.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Frings
authors.affiliation: Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. ak_wiontzek@freenet.de.
authors.forename: Ann-Kathrin
authors.initials: AK
authors.lastname: Wiontzek
authors.affiliation: Department of Respiratory Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. klose@uke.de.
authors.forename: Hans
authors.initials: H
authors.lastname: Klose
authors.affiliation: Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. s.kluge@uke.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kluge
mesh_terms: D000208:Acute Disease; D000368:Aged; D001999:Bronchoscopy / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D063087:Noninvasive Ventilation / Q000379:methods / Q000592:standards*; D010102:Oxygen Inhalation Therapy / Q000379:methods / Q000592:standards*; D018583:Pliability; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*