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High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy--a prospective randomised trial.
Crit Care. 2014 Dec 22; 18(6):712.CC

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.

Authors+Show Affiliations

Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. m.simon@uke.de.Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. sbraune@uke.de.Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. d.frings@uke.de.Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. ak_wiontzek@freenet.de.Department of Respiratory Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. klose@uke.de.Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. s.kluge@uke.de.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

25529351

Citation

Simon, Marcel, et al. "High-flow Nasal Cannula Oxygen Versus Non-invasive Ventilation in Patients With Acute Hypoxaemic Respiratory Failure Undergoing Flexible Bronchoscopy--a Prospective Randomised Trial." Critical Care (London, England), vol. 18, no. 6, 2014, p. 712.
Simon M, Braune S, Frings D, et al. High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy--a prospective randomised trial. Crit Care. 2014;18(6):712.
Simon, M., Braune, S., Frings, D., Wiontzek, A. K., Klose, H., & Kluge, S. (2014). High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy--a prospective randomised trial. Critical Care (London, England), 18(6), 712. https://doi.org/10.1186/s13054-014-0712-9
Simon M, et al. High-flow Nasal Cannula Oxygen Versus Non-invasive Ventilation in Patients With Acute Hypoxaemic Respiratory Failure Undergoing Flexible Bronchoscopy--a Prospective Randomised Trial. Crit Care. 2014 Dec 22;18(6):712. PubMed PMID: 25529351.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy--a prospective randomised trial. AU - Simon,Marcel, AU - Braune,Stephan, AU - Frings,Daniel, AU - Wiontzek,Ann-Kathrin, AU - Klose,Hans, AU - Kluge,Stefan, Y1 - 2014/12/22/ PY - 2014/07/22/received PY - 2014/12/08/accepted PY - 2014/12/23/entrez PY - 2014/12/23/pubmed PY - 2015/10/20/medline SP - 712 EP - 712 JF - Critical care (London, England) JO - Crit Care VL - 18 IS - 6 N2 - 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. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/25529351/High_flow_nasal_cannula_oxygen_versus_non_invasive_ventilation_in_patients_with_acute_hypoxaemic_respiratory_failure_undergoing_flexible_bronchoscopy__a_prospective_randomised_trial_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0712-9 DB - PRIME DP - Unbound Medicine ER -