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Go with the flow? High flow nasal cannula for bronchoscopy
  1. Prema Nanavaty1,
  2. David J Feller-Kopman2
  1. 1Pulmonary & Critical Care Medicine, Rush University Medical Center, Chicago, Illinois, USA
  2. 2Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  1. Correspondence to Dr Prema Nanavaty, Pulmonary & Critical Care Medicine, Rush University Medical Center, Chicago, Illinois 60612, USA; prema_nanavaty{at}rush.edu

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Flexible bronchoscopy is a cornerstone diagnostic and therapeutic procedure in pulmonary medicine. Since its first introduction in the late 1960s,1 bronchoscopy has evolved and improved over time. It has gone from a tool used for simple visualisation of the airway to a modality that can be used for simple tasks from surveying the airway to complex therapeutic interventions often done by an interventional pulmonologist. With its long list of indications, flexible bronchoscopy is commonly performed in patients with an array of comorbidities, and, as with all procedures, is associated with complications. For this reason, it is up to the proceduralist to adequately asses their patients and decide how to best proceed to minimise the risk of complications.

Hypoxaemia associated with bronchoscopy can occur before, during, and/or after the procedure. Many patients are hypoxaemic even before the procedure starts. Likewise, hypoxaemia can be worsened due to the administration of a sedating agent, resulting in central respiratory depression and apneic or obstructive processes. The insertion of the bronchoscope past the glottis into the trachea can itself induce hypoxaemia.2 Taking into consideration a normal diagnostic bronchoscope with an outer diameter of 4.2 mm and the diameter of the trachea being between 15–20 mm, insertion of the bronchoscope can cause an element of airway obstruction that can exacerbate hypoxaemia, especially in someone who already has underlying lung disease.3 Suctioning during a bronchoscopy can cause atelectasis and …

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Footnotes

  • Contributors PN and DJF-K have contributed to the writing of the attached editorial. PN had a substantial contribution in the conception and design of this editorial with guidance from DJF-K. Final review was done by both authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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